Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Hospitals, Health Systems Don’t Feel Prepared For Meaningful Use Stage 2

Posted on December 31, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new survey by KPMG confirms what most us would have guessed — that hospital and health system leaders aren’t that sure they’re ready to meet Meaningful Use Stage 2 requirements.

The study, which was conducted last month, found that 47 percent of hospital and health system business leaders surveyed were only somewhat confident in their readiness to meet Stage 2 requirements. Just over one-third (36 percent) said they were confident, and four percent weren’t confident at all, KPMG found. Another 11 percent said they didn’t know what their level of readiness was.

Respondents are also worried about meeting privacy and security standards included in both Stage 2 and HIPAA. Forty-seven percent of respondents were only somewhat comfortable with their organization’s ability to meet all parts of HIPAA, including the need for new annual risk assessments and protecting patient-identifiable information. Eight percent of respondents said they weren’t comfortable at all, 13  percent said they weren’t sure and 31 percent said they were comfortable, KPMG reported.

To help close the readiness gap, hospitals and health systems are bringing in outside help. Thirty percent of respondents said their organization had hired new or additional team members to help complete EMR deployment. And 22 percent said they’d hired outside contractors to get the job done.

So why are so many healthcare business leaders insecure about Stage 2?  When asked to name the biggest challenge in complying with Stage 2 requirements, 29 percent cited training and change management issues.

Tied for second were lack of monitoring processes to ensure sustained demonstration of MU, and capturing relevant data as part of the clinical workflow, at 19 percent each. Twelve percent named lack of a dedicated Meaningful Use team, and 6 percent availability of appropriate certified vendor technology. Fourteen percent said “other.”

VA Plans Baseline Repository for VistA

Posted on December 28, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Right now, there are 133 instances of the VA’s popular VistA software operating across the U.S. In an effort to create some harmony, the VA has set plans to create a special separate repository for its Gold Disk version of VistA which developers can use as a baseline.

According to Healthcare IT News, the VA is also planning a software testing platform, open source dev standards and documentation of open source community outreach planning.

The idea behind the VA’s move is to attract more developers and code contributions to VistA, which despite its popularity is getting a bit long in the tooth at more than 30 years old, HIN reports.

VistA is already being renovated by the community managed by the Open Source Electronic Health Record Agent (OSEHRA), a not-for profit created by a previously standing contract between the agency and The Applications Informatics Group.

The group is working to create a minimum baseline standard for VistA code behind 20 key modules. To do that, OSEHRA’s working with VA’s internal development team to clean up the code and leverage what works.

Meanwhile, OSEHRA is working as a custodial agent is to certify open source code for integration into the VistA code base and to make sure complimentary software contributions will work with VistA.

According to estimates cited by HIN, OSEHRA should cost less than $10 million per year, while replacing VistA with an existing commercial EMR could cost about $16 billion. (Yeah, there’s a no-brainer for you.)

In any event, the big idea behind all of the VA’s VistA efforts is to get things moving quickly and bring on the innovation.  It’s hard to argue that this is a good idea. Whether OSEHRA itself is the right vehicle to guide and channel this innovation is anybody’s guess, but if it can harness the explosive creative force that is the open source community, watch out!

2013: The Year Of The EMR Switch

Posted on December 27, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

After years of ferment, it looks like this is going to be a year when many a hospital decides to rip and replace their system.

Pundits of various stripes like to dwell on the big-ticket installations — some in the many hundreds of millions of dollars — and yes, those folks are not very likely to back out. But those same pundits are beginning to note that a high percentage of hospitals (and doctors, by the way) are growing unhappy with the EMRs they’ve got.

What has so many providers in agreement that their system doesn’t cut it? Maybe it’s the pressure to meet Meaningful Use 2 standards. Maybe it’s a recognition that their system requires too much care and feeding. Or maybe,  just maybe, the fact that doctors hate the system they’ve got is finally filtering through.

Regardless, if there is a wave of hospital EMR switches, it could have a big impact on the EMR sales process:

Vendors will market their heads off:  With lots of new contracts up for grabs, vendors would be crazy not to spend on marketing like they never have before. But they’d better be selling confidence — think the “we’re the people you can trust” ads run by life insurance companies — or it won’t win a lot of fans.

Hospitals will be sadder but wiser:  All of that happy marketing stuff aside, hospitals will (hopefully) be harder to convince and clearer on what they want. That means doing some long, sober, careful analyses of what went wrong the previous time, but nobody will be rushing into things this time, so why not?

Alternatives (like open source) may see more momentum:  With hospitals having already sunk big money into products that didn’t make the cut, maybe this time they’ll give free open source EMRs and health IT infrastructure a chance.

New market winners and losers will emerge:  Right now, the same 10 or 15 players are usually turning up in EMR satisfaction surveys.  With a big switch going on, some may lose their pride of place and new winners may emerge. It would be pretty surprising if every hospital EMR switcher just jumped on the same products that already dominate the market.

Maybe this time, with Meaningful Use experience under their belt and some experience with a live EMR, the (re)selection process will go better this time. Let’s hope so!

New Hospital Rockets To Top Of HIMSS EMR Adoption Scale

Posted on December 26, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s a story of what can happen when a hospital starts out from scratch with the latest in EMR knowledge, rather than having to integrate its system bit by bit.

Texas Health Alliance, a 50-bed acute-care hospital based in north Fort Worth, has been named as achieving the rarely-seen Stage 7 in HIMSS Analytics EMR Adoption Model. At present, only 103 U.S. hospitals, or 1.9 percent, are currently at Stage 7.

Some of the outstanding features of the rollout include:

* Over 95 percent utilization of CPOE (driven predominately by well-designed order set content, HIMSS says)
* Advanced clinical decision support alerts that support best practice protocols
* Smart use of an enterprise data warehouse used to monitor best practice alerts and core measures
* Closed-loop medication administration environment

This award is interesting given that small hospitals have been well behind the curve in Meaningful Use and meeting the HIMSS standards.  But there’s some obvious reasons why it’s been so successful.

For one thing, THA has been open only since September. I’ll bet many readers would kill for the clean slate that offers the IT people there. No need for expensive integration projects to bring the new EMR on board; no having to switch staffers from one technology to another; no major transition from paper to digital; and the list of benefits goes on.

Another major factor working in its favor is that THA is part of nonprofit hospital system Texas Health Resources.

A tiny hospital backed by a sizeable IDN is in a different position entirely than an independent critical access hospital, so it’s not exactly astonishing that it zoomed ahead. And when the parent chain already has its own (Epic) install well under way — and an engaged community of users — that knowledge goes a long way.

Too bad most hospitals can’t start out fresh the way THA did. Innovation always comes easier if it isn’t competing with the stuff you’ve already got.

Happy Holidays and Merry Christmas!

Posted on December 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

I’ll be taking a little break for the beautiful Holiday Season. I did do a post on EMR and HIPAA called All I want for Christmas… where I look at what I’d love to see happen with healthcare IT and EHR. It applies to Hospital EHR just as much as ambulatory so take a look.

I hope everyone has a wonderful and safe Holidays! I’ll take off a few days around Christmas, but will be back before the end of the year.

Thanks everyone for reading! It’s been a great year on Hospital EMR and EHR. Next year should be even bigger!

Top 10 Hospital EHR Vendors By Installed Systems

Posted on December 21, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

I came across this list of Top 10 Hospital EHR vendors by installed systems on Dark Daily (a great resource, particularly if you’re into Labs). The data is a little dated, but I thought it would be interesting to consider the numbers in 2011 and how they might look different today. Here’s the list:

Vendor Name Total Installations Percent of Installations
• Meditech 1212 25.50%
• Cerner 606 12.80%
• McKesson 573 12.10%
• Epic Systems 413 8.70%
• Siemens Healthcare 397 8.40%
• CPSI 392 8.30%
• Healthcare Management Systems 347 7.30%
• Self-developed 273 5.80%
• Healthland 223 4.70%
• Eclipsys (Bought by Allscripts) 185 3.90%

This list was taken from the HIMSS Analytics database. I wish I had access so I could compare these numbers for 2012. The interesting thing is that I’m not sure the Hospital EHR vendor numbers would be all that much different. Epic is the media darling, but its focus is squarely on the large hospital systems so they often lag behind when it comes to total installations.

Impossible to Say “Wrong EHR”

Posted on December 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

It seems that the CIO’s are defending the choice of EPIC because it is politically impossible to say they made a wrong choice after so many resources, money and time have been expended.

The above statement is incredibly scary for me to consider. In reality, it’s the opposite of the oft quoted statement, “no one gets fired if you choose IBM.” In healthcare I’ve often heard people say a hospital CIO doesn’t get fired if he chooses Epic.

We’ve all heard about Epic’s tactics for selecting which hospitals can use their EHR. They are highly selective and say no to a lot of hospitals that they don’t think are the right fit for Epic (whatever fit that might be). I even heard one rumor on HIStalk that when an Epic install goes downhill, Epic will offer to pull out and refund all of the money or require that the hospital pay them a lot of money to have Epic send in a recovery team to try and get the Epic EHR install back on track.

When a hospital has invested hundreds of millions and even billions of dollars on a specific EHR software, things can get messy really fast. Imagine you’re a hospital CIO (which many of you that read this site are) that had just spent hundreds of millions of dollars on Epic. Would you be able to go back to the CEO or CFO and say that it was the wrong choice. That’s not an easy discussion to have and I expect very few hospital CIO’s have the gumption to have that conversation.

Although, let’s not put all of this on Epic. Certainly some of the same dynamics are exhibited by all hospital EHR purchases regardless of EHR vendor.

Besides the large contracts that are signed with EHR vendors, the other major reason hospital CIO’s can’t say that they made a mistake in their EHR selection is because of the lack of EHR data liquidity. Once you start entering your data into an EHR, getting it out is like climbing Mount Everest. Only a few people know how to do it, most aren’t successful, and its guaranteed to cost you a lot of money. If EHR vendors would free up the EHR data, it still wouldn’t be an easy decision, but it would help.

Oops! Community Hospitals Unhappy With EMR Purchase

Posted on December 18, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new report from KLAS seems to confirm what we all know already — that buying an EMR is a tricky business that can easily end in failure.  The new KLAS report found that increasingly, community hospitals are questioning whether they bought the right EMR, and that a substantial number are already ripping out and replacing their system.

The authors of the report found that about 200 hospitals with less than 200 beds said they were planning to replace their EMR. And in an even more dramatic turn, KLAS found that one in three community hospitals who’d gone live with their EMR in the past 12 months felt they’d made the wrong decision.

Epic had the most overall community hospital wins for 2011, followed by Healthland, Cerner and CPSI. Looked at another, by market share, Meditech came in first with 20 percent, followed by Epic and Cerner, both with 12 percent.

This ferment comes against a backdrop of bigger institutional changes, in which smaller hospitals are joining integrated delivery networks, and as a result, are being shoehorned into using enterprise systems like Epic and Cerner already in place within the IDNs.

This level of disappointment in technical investments would be pretty remarkable in just about any industry. Given the pressure to get on the Meaningful Use train, it’s perhaps a bit less surprising, since pressure to invest can lead to fatal flaws in just about any decision-making process. Still, as an observer, it alarms me to see just how common EMR dissatisfaction is in smaller community hospitals.

As we’ve noted here before, giant institutions making giant investments seem a lot less prone to expressing dissatisfaction with their EMR.  Maybe it’s because those hospitals really are getting more for their money — who knows? But my guess is that they’ve as prone as smaller hospitals to wish they’d gone another way, given how hard it is to make an enterprise software buy that pleases everybody.

In any event, let’s hope that community hospitals largely make their peace with the EMR they’ve got. Rip and replace can’t be good for morale, finances or patient care.

Hospitals, Health Systems And Clinics Adding Portals, But Consumers Not Synched Up

Posted on December 17, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

With Meaningful Use Stage 2 requiring that 5 percent of patients use them, a growing number of health systems, hospitals and clinics have rolled out patient portals, according to a recent study by KLAS. In fact, 57 percent of providers now offer a portal, typically connected to their enterprise EMR, KLAS found.

The thing is, somehow these efforts aren’t reaching consumers. In a new Wolters Kluwer Health survey of 1,000 consumers, only 19 percent said that they have access to a personal health record.

It’s not that patients don’t want to be engaged in their health — 80 percent of respondents said greater control of healthcare is positive — but it seems that they either don’t like or don’t know how to find the portals available to them.

Ultimately, the broad mass of consumers simply don’t seem to see a crying need to use portals as of yet. Seventy-six percent of respondents to the Wolters Kluwer survey said that they have the information and tools they need to manage basic healthcare functions such as choosing providers and researching treatment options, clearly dwarfing the number who care to look at their own patient data.

That being said, there’s a small (but I’d argue, growing) minority of patients who do take connections with providers seriously. Nineteen percent of respondents told researchers that the ability to communicate via e-mail with doctors and nurses and schedule appointments online was an important factor in choosing a medical practice. In other words, there’s clearly a wired contingent out there which would probably respond well to a truly useful portal.

How can hospitals and clinics get patients engaged in PHR use?  My gut instinct is that consumers won’t give a hoot about PHRs until they become a tool that’s part of their medical or hospital visit. If doctors work with a PHR, turning the visit into a collaboration, patients will be motivated to follow up and review what they’ve learned.

I guess what I’m saying is that we should start by getting doctors engaged with PHRs as a means of getting patients involved. If they do that, PHRs will go from being some Web site to a valuable tool for sharing care information.  If not, don’t expect the number of PHR-interested consumers to climb anytime soon.

Hospitals Stepping Up Security Risk Analysis, While Practices Lag

Posted on December 14, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As hospitals have implemented EMRs, they’ve created a tempting target for criminal hackers, as the goldmine of patient data they house can be very valuable on the black market.  At the same time, patient access to health data has expanded dramatically, expanding possible points of failure.

Aware of these issues, hospitals are almost all conducting an annual security risk analysis, but fewer medical practices are on the bandwagon, according to new research by HIMSS.

Since 2008, HIMSS has conducted an annual security survey of healthcare providers, supported by the Medical Group Management Association and underwritten by Experian Data Breach Resolution. That first year, three-quarters of respondents (largely hospitals) said their organization had conducted an annual risk analysis.

For 2012, a total of 303 individuals completed the HIMSS survey, a self-selected Web-based survey. Those responding had to answer qualifying questions which verified that they were involved directly in working with security at their organization.

This year, a full 90 percent of hospitals reported conducting an annual risk analysis, while just 65 percent of physician practices said that they do so. (I’m actually surprised that so many physician groups are doing any kind of audit, but maybe the respondents came from larger practices.)

What’s really interesting, though, isn’t the mere fact that these organizations are taking their medicine and doing their risk surveys.  Some other highlights of the study:

* Twenty-two percent of respondent reported a security breach in the last year: While scary to contemplate, it’s nonetheless true that both hospitals and medical practices had a one-in-five chance of being breached this year. Most breaches affected less than 500 patients, but providers can’t count on that being the rule.

* Less than half of the hospitals and doctors had tested their data breach response plan:  Auditing your security arrangements is all well and good, but if you’re not sure your data breach plan will actually help you respond to breaches, it’s not worth the (digital) paper it’s written on.

As the pressure mounts to protect EMR data — across patient portals, mobile devices, laptops, desktops and more — let’s hope that physicians catch up with hospitals when it comes to security.  Otherwise, I think 2013 may be remembered as the year big ‘n ugly physician practice break-ins dominated the news.