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!

Remote Patient Monitoring Going Mainstream

Posted on January 31, 2013 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.

This week I read a piece of news which suggests to me that we’re seeing a turning point in the use of remote monitoring technology to manage patients.  It looks like AT&T is taking a major public position in support of remote monitoring via the cloud, via a partnership with a  hot new startup that just raised funding, according to a report in mobihealthews.

According to the mobile health news publication, cloud-based patient monitoring company Intuitive Health just got a $3.4 million investment in what appears to be the company’s first public round of investment.

Intuitive, which completed a pilot with health system Texas Health Resources and AT&T last year, offers cloud-based remote monitoring software which can interface with any device.

The pilot involved monitoring CHF patients remotely for 90 days using wireless pulse oximeters, blood pressure cuffs and weight scales, plus tablets and apps feeding the data to the  patients’ EMR records. During the pilot, THR reduced hospital readmissions for chronic heart failure patients by 27 percent, mobihealthnews reports.

According to a press release from AT&T, Intuitive’s software has since become a key component in the telecom giant’s own SaaS patient monitoring product.

Remote monitoring has been a hot topic of discussion and an emerging approach for several years, but hasn’t found an established place in day-to-day care for most institutions.  With AT&T and Intuitive offering a device-agnostic model, however, I believe they will give a boost to the use of remote monitoring generally.

Personally, I’ve been cheering for remote monitoring to succeed for some time; after all, given how mobile-device-oriented people are anyway, it just makes sense to leverage those capabilities to improve their health.  I hope this represents a turning point for this type of technology and that we see news of more successful pilots this year.

Patients Question Clinical Decision Support Use

Posted on January 30, 2013 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.

Using clinical decision support technology (CDS) is such a standard and helpful health IT approach – not to mention a central Meaningful Use feature — that we almost take its existence for granted. Apparently, however, patients aren’t as tolerant of computer-assisted decision making as clinicians and IT experts are, according to a new study published in Medical Decision Making.

The study suggests that patients actually distrust physicians who use CDS, labeling them as “less professional, less thorough, and having less diagnostic ability,” according to a report by EHR Intelligence.

The study, done by University of Missouri researchers, showed participants vignettes depicting an exam for an illness or injury. These participants were then asked to rate their reactions to the physicians showed in the vignettes.

The results suggest strongly that potential patients are unnerved by the notion of physicians making use of CDS.  Researchers found that the study subjects were less likely to trust computer-driven diagnoses, and moreover, less likely to be happy with a positive outcome if that outcome involved CDS use.

Perhaps the only social benefit to physicians using CDS was that subjects were less likely to blame a doctor for a negative outcome if the doctor relied on CDS to make a decision.  If a doctor used CDS, ignored its conclusions then had a negative outcome, patients felt strongly that he or she was deserving of punishment.

It’s not exactly good news for healthcare providers that patients are likely to be squeamish about their using CDS. That being said, my guess is that doctors can do a lot to make patients comfortable simply by explaining what they’re doing and making patients feel confident about the process. In the end, after all, patients care most about their relationship with the provider, computer-aided or not.

One Vendor’s Take On Building Usable Health IT

Posted on January 29, 2013 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.

Virtually anyone reading this blog has strong opinions on how to build usable health IT and what it the final product should look like. Now and then, though, I still think it’s worth tossing out somebody else’s version to see whether it adds to the conversation.

In that spirit, via Healthcare IT News, I bring you some of the views of  Joe Condurso, president and CEO of health IT vendor PatientSafe. Condurso, whose company works to marry consumer mobile trends with enterprise clinical IT, offered the following recommendations on building usable HIT:

*  Responds to context: A good system must “run on contextual analytics,” Condurso told HIN. “It’s connected to the back end, connected to all of the policies and procedures [an organization] is trying to implement, but were stuck in a three ring binder.”

*  Slips into existing processes:  If health IT goes with, not against existing workflow, that makes it easier for it to generate documentation for clinicians. In his view, well-designed technology “fortifies and creates all of t he documentation on the back end,” saving physicians time and effort.

* Is mobile:  This one’s a no brainer: since physicians these days have a mobile workflow, health IT needs to go mobile.  He notes that mobile tech doesn’t just allow clinicians to compute on the fly, it also means that when, say, a nurse needs to find a doctor, they don’t need to go on a safari to find them physically.

Starts from mobile design:  Condurso believes health IT UIs should start from mobile designs, then move up from there.  “The UI has to be able to yield important information and synthesize that in a small screen format,” he says. “You have to start with mobile and build up.”

So there you have it: a few more UI ideas to toss onto the conversational fire. I particularly liked Condurso’s notion that UI design should start mobile and work upward. What about you?

Reasons Hospitals Acquire Medical Practices

Posted on January 28, 2013 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.

The Charlotte Observer did a great report on the shift to hospital owned medical practices. For those not familiar with the shift, here’s the numbers the article offers:

Last year, 47 percent of U.S. physicians were employed by hospitals – roughly twice the percentage in 2002, according to surveys by the Medical Group Management Association.

One health care recruiting company predicts that hospitals could employ as many as 75 percent of U.S. doctors within two years.

I still think that some of this shift is cyclical, and independent thinking doctors will eventually leave their hospital overlords and be back on their own again. However, considering the financial side of the equation, many doctors might not be able to go back to their own practice even if they want to do so.

Here’s an example from the article that explains one of the reasons that hospitals are acquiring medical practices.

Gary Ziomek can vouch for that. The Waxhaw resident began getting physical therapy in 2011, after undergoing an unsuccessful spinal fusion surgery. He went to a therapist at Carolinas Rehabilitation on the campus of Carolinas Medical Center-Pineville hospital.

Early this year, his bill was $148 for 30 minutes of massage. But starting in May, the charge for a 30-minute massage rose sharply, to $249.30 – even though he got the same therapy from the same therapist in the same building.

Ziomek said an employee told him the higher charge came about because the office, which is owned by Carolinas HealthCare, began billing as a hospital-based setting. He said he was told that patients could go to the Ballantyne office and pay the lower amount.

Ziomek’s Aetna insurance reimburses differently based on where a service is rendered. For an office visit, Ziomek was responsible for a $20 co-pay, no matter if he had met his $250 deductible. For a hospital visit, he pays 10 percent of the bill after paying the $250 deductible.

In this case, Ziomek’s out-of-pocket expense dropped, because he had already met his deductible for the year. But he’s concerned that the overall cost went up, with no change in service or quality.

“Somewhere along the line, they realized, ‘We can charge more to the insurance company even though the patient is getting exactly the same service,’ ” said Ziomek, 70, a retired investment banker. “They could have kept the lower rate, but they chose not to. Why? Because of greed.”

I think the last line about greed is a little bit of sensationalism. In our market, healthcare is driven by revenue and profits. Many hospitals say they’re non-profit, but they certainly act like for profit entities.

What’s surprising to me is that insurance companies are putting up with this shift. I expect the loophole will be reversed again, but that often takes time. Some policy will be put in place to stop hospital owned medical practices from charging at the hospital rate. However, until that happens you can be sure that hospitals will continue their acquisition of medical practices.

Accenture: Five Questions Hospital Boards Should Ask Before EMR Buys

Posted on January 24, 2013 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 we’ve noted in the past, hospitals are on not only an EMR buying binge, they’re doing a lot of switching from one EMR to another. Check out these stats from Accenture:

Accenture research shows that 4 to 4.5 percent of hospitals plan to make an EMR buying decision each year. This
could exceed 110+ EMR contracts or 200 to 250 hospitals per year. This trend is expected to continue well into the
future. In fact, in 2012, 50 percent of EMR deals [were] replacements, up from 30 percent in 2011, according to KLAS Research.

Whether your hospital is a switcher, a late adopter or  planning some kind of EMR upgrade, it’s making a decision of grave importance. So what are some of the key considerations boards should bear in mind? Here’s Accenture’s list of five key questions boards should keep front and center as they consider (more)  big EMR investments and plan for the future:

*  Does your current system offer enough functionality to meet up and coming Meaningful Use requirements, such as the ability to make patient family health histories and imaging results available? Does your current or contemplated EMR vendor have plans in place to keep up with future requirements/changes?

*  Is the EMR vendor’s development strategy in line with your strategy? “Boards should ask of the EMR vendor: do they have adequate resources…to help complete the business roadmap on time and successfully?” Accenture asks. And just as importantly: “Can the vendor help ensure that future product functions are strategically aligned to the healthcare [system's] key initatives?”

* Is your hospital currently on track to meet ICD-10 adoption and Meaningful Use Stage 2 requirements?  Is your vendor going to be able to help support you in these efforts as your hospital works to meet these multiple goals, or does it lack the resources to do so?

* If we decide to switch EMRs, do we have the internal resources needed to support such a bandwidth-sucking effort? Given competition for healthcare IT labor today, will you have the ability to hire on additional resources if needed? And while you’re at it, is your C-level and IT leadership solid enough to make such a treacherous journey?

* Can your hospital afford to switch EMRs, bearing in mind not only direct costs such as licensing, implementation and new technical support, but also ongoing support costs in the neighborhood of 20 percent per year?

To answer these questions, Accenture recommends you conduct an independent analysis of EMR vendors (presumably, rather than relying on analyst firms or peer feedback exclusively).  This sounds like a very good idea to me.

What Hospitals Can Learn From Airports

Posted on January 23, 2013 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.

Few of us would want to get our healthcare in the cavernous, emotionally sterile barns that are today’s airport terminals. (We definitely wouldn’t want to face a security checkpoint before we could get our care.) But there’s a fair amount of technology, data use and workflow that hospitals could intelligently borrow from airlines, as well.

Here, in no particular order of priority, are some approaches hospitals could borrow — or use more effectively — from an airline terminal:

*  Kiosks:  Sure, hospitals use kiosks, but far too few hospitals bother.  And when they do use kiosks, it’s largely about billing and perhaps appointment setting/confirmation.  Why not create a “patient card” with the ability to display a patient’s care status on a kiosk  (“Jane Smith is in imaging as of 5:32  p.m.”) and seed all of the main thoroughfares of the hospital? This would be of enormous help in orienting caregivers and for that matter, staff.

* Big-screen displays:  Yes, obviously, patient information can’t be displayed as casually as flight departure/arrival updates. But if a patient gets a code (tied to the card I mentioned above) patients and caregivers could know where to go and when. In the ED, smaller displays could show room-bound patients what activities are planned for them in what order. (Note: Check out John’s post on other uses of Digital Signage in Healthcare for similar ideas)

Wandering helpers:  When airlines are particularly busy, they sometimes send out members of their staff to wade into lines and help passengers get where they are going.  Equipped with a modified tablet accessing the same information as the kiosk, these hospital helpers could be stationed in high-traffic areas and available to help patients and family get where they need to be to participate in care. For patient-specific information, people could present their “patient card” and learn about the status and location of the specific patient.

Along with technology-based approaches like these, I’d also like to see hospitals offer a terminal-like retail strip for visitors, many of whom spend huge blocks of time on the campus and don’t have a chance to eat properly or get small errands done. But that’s for another story, perhaps. In the meantime, I think we need to look closely at how airlines marry people flow and technology — it could be a good thing for the industry.

What Would It Take To Get More Hospitals On VistA?

Posted on January 22, 2013 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.

Recently, we shared the story of of a California community hospital that decided to bypass big vendors like Cerner and Epic and go for a VistA installation instead. While Oroville Hospital ended up spending $10 million on its VistA implementation, that turned out to be about half of what it would have spent on Cerner and its big-vendor cousins. Then, to boot, Oroville got a $5 million Meaningful Use payout.

Yes, without a doubt, Oroville had a different experience when it went with VistA than it would have if it hired on Epic and had armies of be-suited consultants descend onto its campus. Any open source project faces the risk that the fervor and volunteer labor that makes up the backbone of its ongoing development efforts.

But given how much flexibility hospitals get out of the deal, and how much they save, it seems to me that you’d still expect to see more VistA projects being mounted.  What would it take? Here’s a few ideas:

*  Get a CCHIT-certified VistA product out there:  Right now, hospitals don’t have such a choice. The only reason Oroville got its instance certified was thanks to special help from World VistA.

* Have more happy talk stories on how VistA can really work appear in serious business publications like Forbes:   Arguably, peer pressure is a major reason hospitals stick to a short list of popular solutions.  More coverage of VistA successes in major pubs creates its own buzz which may encourage IT leaders to reconsider their existing plans.

* VistA consulting firms need to become more common:  Right new there are a few firms, like Medsphere, that will walk hospitals through the VistA installation process. But what if, say, Accenture had a division devoted to VistA support?

There’s not a lot you can do if a hospital CEO is determined to buy Epic or Meditech or Cerner. But if they want to consider VistA, there’s a lot the industry could do to help.

Other EHR Options When Epic Denies You

Posted on January 18, 2013 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 got the following email from the CIO of a hospital.

They’ve [Quadramed] got the whole ONC-ATCB certified EHR for Phase 1 MU (although the point in your post is valid about that certification being fairly general anymore). They are working on obtaining and integrating/interfacing ambulatory functionality for physician practices, but for hospitals they have some pretty good sized hospitals running their QCPR product. KLAS includes them in their evaluation of EHR vendors (along with the likes of Allscripts, Cerner, Epic, GE, McKesson, Meditech, and Siemens) although they clearly don’t have as many installed hospitals that most of that list has. They also need to develop some real patient portal type of functionality to stay certified for future MU Phases. Not a market leader, but they are a market player. In spirit of full disclosure, we are almost live with Quadramed product, and we will be using it as a full EHR for both inpatient and outpatient care settings. We could not afford the bigger vendor solutions, and Epic wouldn’t even talk with us because we are below their minimum size to qualify for their sales efforts….only vendor I’ve seen that has that luxury of flat out ignoring possible business. We didn’t like the inflexibility of the lower end EHR vendors, and Quadramed provided a lot of the flexibility of bigger vendors for the price of the smaller vendors.

I’d love to learn where other hospital CIOs turn when Epic won’t give them the time of day. Considering Epic’s hospital size requirements and who they will work with, this is more hospitals than not. I started a list of hospital EMR and EHR vendors that might help. Where do hospital CIOs go when Epic isn’t an option? Is there a Denied by Epic support group somewhere online where hospital CIOs can commiserate?

Hospitals Beware: EMR Copy And Paste Common

Posted on January 16, 2013 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.

EMR templates are both a curse and a blessing. On the one hand, they systematize clinical data in a way that makes it far easier to share, aggregate and study trends. But the down side, and it’s a big one, is that EMR templates tempt clinicians to save time by cutting and pasting old data from patient’s record into current visit notes.  The following study gives us a look at just how easily copy-and-paste can become a (bad) habit for clinicians in a hospital.

To study template use, an assistant professor at Case Western Reserve University School of Medicine brought together a group of colleagues to examine EMR-based progress reports. The group looked at 2,068 electronic progress reports created by 62 residents and 11 attending physicians, all of whom were working in the intensive care unit of a Cleveland hospital.

To determine how common cut-and-paste content was in the notes, the researchers reviewed notes for 135 patients over a five-month period using plagiarism-detection software, iHealthBeat reports. The results?  They found that 82 percent of progress notes created by residents contained 20 percent or more of copied and pasted material from patient records.  Meanwhile, 74 percent of progress notes created by attending physicians contained 20 percent or more of material cut-and-pasted from patient EMR records.

I’m not writing this to beat up on doctors, who certainly have their hands full simply coping with the new systems. Cut-and-paste is a natural instinct when you’ve spent your life doing so successfully in Word docs and spreadsheets. But as the iHealthBeat piece points out, courtesy of EHR Intelligence, there are reasons to be concerned when this much copying is going on, including outdated records, incorrect billing requests and worst of all, mistakes in documentation which could harm vulnerable ICU patients.

Seems that cutting and pasting within EMR documentation is a problem that’s not going to go away on its own.

A Hospital Chooses VistA EMR Over The Giants

Posted on January 15, 2013 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 out of the pages of Forbes which should make open source advocates happy. In it, we hear the tale of a northern California hospital which decided to buck corporate trends and go with VistA rather than pay for a big-ticket EMR from a vendor giant.

Three years ago, at the outset of its EMR search, Oroville Hospital was going down the same path as most of peers. But the CEO wasn’t terribly happy with that path. While the 153-bed hospital had shortlisted giants like Cerner, McKesson and Meditech as possible candidates, chief executive Robert Wentz was worried about the sky-high cost, disruption and — as a smaller facility — lack of clout with vendors, Forbes reports.

Shunning conventional choices, Wentz decided to take a risk on VistA. Not only did he go with the less-conservative choice, he decided not to partner with companies like Medsphere that help hospitals integrate and develop VistA to meet their needs. Instead, he chose to work with independent VistA experts (a rogue crew with day jobs of their own) rather than be tied to a particular vendor.

To coordinate the project, Wentz worked with the non-profit WorldVistA and Vista Expertise Network, both of which embrace hundreds of programmers with VistA smarts. Wentz worked with programmers from the two groups, not only to build  out the hospital’s EMR but also to develop additional add-ons such as an e-prescribing package. WorldVistA CIO helped Oroville get its package certified for Meaningful Use, which brought in $5 million.

Now, three years into the project, Oroville has spent about $10 million on its EMR, about one-half of what it expected to spend on the giant EMR-makers’ software.

Now, it’s worth bearing in mind that Wentz and his IT team had to be more flexible than they would have if an army of consultants from Cerner or Epic had run the show. (I love the part in the Forbes story where a programmer told Wentz he had to end the call so he could make a trip to Costco. Classic.)  But Oroville seems to have reaped the benefits.  I wonder if this story will lead to more VistA adoption…