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!

How Easy Are Hospitals Hacked?

Posted on July 31, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

This is an interesting tweet. I find it interesting that a hospital is working with local hackers. I guess it’s even more interesting that an EMR vendor has enough clout to be able to get a local hospital to not install software. Although, knowing the industry like I do, it’s not that surprising. Should a hospital listen to some local hackers or someone they’ve invested hundreds of millions and sometimes billions of dollars in? (yes, an EHR purchase is an investment)

Of course, this tweet reminded me of a great story my best friend in college told me about when he hacked into the major hospital system where he went to high school. Turns out he used a mix of physical and technical hacks to breach the hospital system.

The key to him breaching the hospital system was that he got access to a computer on the hospital system and left a back door for him to access that computer remotely. All he did to do this was put on a jacket, went to an office in the network where he said he was working for their IT department and was there to run some updates on the computer. They happily let him run the “update” on their computer. Instead, he created a back door where he could get access to the hospital network from anywhere.

I’m sure that many reading this will think twice when someone comes in saying they need to update their computer now. It’s not like most people in the hospital know all the tech support people in their hospital.

Of course, this is a simple little hack. Certainly there are plenty of other ways that someone can hack into healthcare systems. The interesting thing is that most people don’t care about healthcare information. They want financial information. So, someone that does hack a healthcare system is unlikely to do much with the healthcare info. Yes, I’ve read the people who say a patient record is worth $50. I’m still waiting to see someone try to sell one at that price.

I should also mention that I think the tweet isn’t actually talking about this type of hacker. I think the tweet is talking about the Fred Trotter version of “hacker” which just puts together a great solution to a problem (ie. a hack). We need more great solutions in healthcare, so I hope that EMR vendors stop impeding local application hackers to work with hospitals.

AHA, AMA Seek More Flexible Meaningful Use Requirements

Posted on July 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.

The American Hospital Association and the American Medical Association have sent a joint letter to HHS Secretary Kathleen Sebelius asking for more flexibility in the requirements for the Meaningful Use program, iHealthBeat reports.

The two trade groups, which called the program’s requirements “overly burdensome,” argue that as the current Meaningful Use program is structured, it’s too hard for some providers to keep up. “[W]e believe that the best way to move the program forward and ensure that no providers, particularly small and rural ones, are left behind is to realign the meaningful use program’s current requirements to ensure a safe, orderly transition to Stage 2,” the letter adds.

The letter makes four recommendations to improve the Meaningful Use program for providers, iHealthBeat notes:

* Let providers meet Stage 1 requirements using either a 2011- or 2014-certified EMR

* Set up a 90-day reporting period for the first year of each new stage of the program, applicable to all providers;

* Give providers increased flexibility to meet Stage 2 Meaningful Use requirements

* Extend each stage of the Meaningful Use  program to a minimum term of three years for all providers

The AHA submitted also submitted testimony to the Senate Finance Committee last week asking legislators to give providers more flexibility within the Meaningful Use program.

As things stand, unless current requirements for electronic clinical quality measures are changed, “clinicians [will be] spending extensive amounts of time working for the EHRs” rather than having the EMRs work for them, the trade group suggested.

As part of its testimony, the AHA presented case studies drawn from four separate hospitals. Based on the issues arising at these hospitals, the group recommended several changes to MU, including using fewer, better-tested electronic quality reporting measures, starting with Stage 2, and making EMRs and electronic clinical quality measure reporting tools more flexible to align data capture with the nuances of workflow.

Larger CO Hospitals On Board With RHIO

Posted on July 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.

Colorado’s hospitals have reached an interoperability turning point. With the addition of Exempla Healthcare’s three Colorado hospitals to CORHIO, the Colorado Regional Health Information Organization, all of the state’s hospitals with 100 beds or more are now connected to an HIE network, reports EMR Daily News.

Right now, 29 hospitals are connected to the CORHIO HIE, with 15 preparing to connect, making a total of 44 hospitals now participating in the exchange. The latest to join are Exempla Good Samaritan Hospital in Lafayette, Exempla Lutheran Medical Center in Wheat Ridge and Exempla Saint Joseph Hospital in Denver.

Along with the hospitals, a total of more than 1,800 office-based physicians, 100 long-term and post-acute facilities, 13 behavioral health centers and five national/regional labs are either connected to or in the process of connecting to CORHIO, according to EMR Daily News.

As impressive as CORHIO’s progress is, there’s still more to be done. There are a total of 61 hospitals located in CORHIO’s service area, which means that the exchange still needs to sign up just under a third of hospitals with access to the network.  Some of the hospitals which haven’t connected up are in rural areas; to help bring them under CORHIO’s wings, the exchange is partnering with the Colorado Rural Health Center.

The ultimate question here, as it is with any HIE, is whether the business model is sustainable.  For the financial year ending September 30, 2012, CORHIO had total revenue of  about $9.7 million (between grants, contracts and implementation fees), and total expenses of $9.5 million. That’s not much of a margin, especially in the capital-intensive world of health IT.

Now, there’s no need to make big profits to provide a public service, but it’s helpful to know that your money is coming from a business model that works. I’d say that this is in doubt in CORHIO’s case. I wonder: are other notable HIEs are doing better?

Business Intelligence And The Smart EMR

Posted on July 26, 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.

A new study by KLAS suggests that while providers are giving thought to business intelligence needs, they still haven’t honed in on favored vendors that they see as holding a leading position in healthcare. That may be, I’d suggest, because the industry is still waiting on EMRs that can offer the BI functionality they really need.

To look at the issue of BI in healthcare, KLAS interviewed execs at more than 70 hospitals and delivery systems with 200 or more beds.

When asked which BI vendors will stand out in the healthcare industry, 41 percent of respondents replied that they weren’t sure, according to a story in Health Data Management.

Of the other 59 percent who chose a vendor, IBM, SAP, Microsoft and Oracle came up as leaders in enterprise BI applications — but none of the above got more than 12 percent of the vote, HDM notes.

Vendors that did get a nod as standing out in healthcare-specific BI included Explorys, Health Catalyst, McKesson and Humedica (Optum). IBM and Microsoft were also singled out for healthcare use, but respondents noted that their products came with high price tags.

Meanwhile, QlikTech and Tableau Software were noted for their usability and data visualization tools though lacking in full BI toolsets, according to HDM.

While these stats are somewhat interesting on their own, they sidestep a very important issue:  when will EMRs evolve from transaction-based to intelligence-based systems?  After all, an intelligence-based EMR can do more to improve healthcare in context than freestanding BI systems.

As my colleague John Lynn notes, EMRs will ultimately need to leverage big data and support smart processes, becoming what he likes to call the “Smart EMR.”  These systems will integrate business intelligence natively rather than requiring a whole separate infrastructure to gather insights from the tsunami of patient data being generated today.

The reality, unfortunately, is that we’re a fairly long way away from having such Smart EMRs in place. Readers, how long to you think it will take before such a next-gen EMR hits the market?  And who do you think will be the first to market with such a system?

Great Whitepaper Summary of OpenVista Features

Posted on July 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

The week after I got my first job implementing EHR, I went into the medical records office where I was shown an article about the government’s decision to open source the Vista EHR software. The HIM manager was drawn by the idea of a free EHR. Of course, the clinic I was working for had already invested hundreds of thousands of dollars on an EHR system. In fact, this is likely what made the HIM manager so interested in the idea of a free EHR. She didn’t know why we’d spent hundreds of thousands of dollars when the government was offering an EHR for free.

What she didn’t understand was that just because the software is free doesn’t mean that the EHR is free. Plus, she (and I at the time) had little understanding of what the Vista EHR software really encompasses. Implementing Vista in that small clinic would have been like taking a sledgehammer to a 2 penny nail. In fact, that might even be underestimating the breadth of what could be done with Vista.

Of course, if we had been in the hospital environment, then we should have definitely considered Vista. However, back then there were a lot of unknowns with how Vista would transition to open source and how it would work in a commercial healthcare environment. 8+ years later, the companies working with the open source EHR is much more mature.

One of the leaders when it comes to implementing Vista in hospitals is a company called Medsphere. Medsphere’s version of Vista is called OpenVista. What’s amazing is the stark contrast in costs between an open source EHR versus many of the proprietary alternatives. No doubt Medsphere and others are benefiting from the billions of dollars the VA spent developing Vista.

For those of you not familiar with Medsphere and OpenVista, check out this whitepaper summary of OpenVista. It’s a really great summary of the capabilities of the software and what Medsphere has done to improve on the Vista software.

I’m sure there are still many hospital CIOs that aren’t brave enough to choose an open source EHR when “know one gets fired for buying Epic.” Although, I think it’s a big mistake when hospital CIOs don’t even consider the open source EHR options. When you see the breadth and depth of what’s available in Vista, it’s definitely worth considering.

Plus, since it’s open source, you can still develop custom additions to the software without worrying whether your EHR vendor will let you create a deep connection to the EHR software. I see an open source EHR software as a great option for those hospitals that are use to developing custom applications in house, but also see how a commercial vendor has expertise that they don’t have in house.

What are your thoughts on Vista as a hospital EHR?

Physician Coaches Can Increase EMR Engagement

Posted on July 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.

Today I read an interesting piece in HealthSystemCIO.com about the approach Naples, FL-based NCH Health System has taken to help its physicians ease into using its EMR.  According to Helen Thompson, VP & CIO, NCH has created a corps of physician coaches to help doctors get and stay comfortable with EMR use.

As she not too surprisingly notes, physicians are her toughest customers, rightfully demanding that the EMR helps them to deliver better care and supports their process. However, getting physicians situated is a very difficult challenge, given that they’re having to learn new processes and a new language.

To address this challenge, NCH has developed a new model for training, involving physician coaches in pre-conversion, implementation and post-conversion support for doctors. While these coaches don’t necessarily have direct clinical experience, they are very knowledgeable about both the EMR and physician workflow issues, Thompson says

The process of using the coaches works as follows:

* Preconversion:  The coaches work on programs for teaching and behavior change management plus develop an online education component.  As the teaching and behavior change takes place, they monitor progress and report as milestones are reached. To make themselves accessible, the coaches provide “concierge-like” services including making rounds with doctors or offices.

* During conversion: Coaches are available for dedicated “at the elbow” support to physicians as needed.

* Post-conversion:  The coaches offer refresher courses and change management support, as well as continuing to be available for at the elbow coaching to physicians as needed.

The coaches seem to be quite a success. NCH has seen a significant improvement in CPOE and electronic documentation measures, with adoption and engagement increased by roughly 5 percent to 10 percent. What’s more, the coaches share physician feedback with hospital leaders, allowing for ongoing improvement. (Thompson also hired a CMIO to further boost the process, which drove up e-documentation and CPOE use by a total of 25 percent.)

From my vantage point, the coaching program sounds like a very good idea. My only question is whether hospital IT departments will typically have the resources to build up a team of coaches, given that they’re generally short on time and staff as it is.  But it does seem to me that it’s a no-brainer for hospitals that can manage it to give this idea a try; after all, getting physicians on board with your EMR is worth just about any effort you put into it.

Study: Massive EMR Vendor Die-Off Expected Over Next Four Years

Posted on July 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.

Well, if you were waiting for someone to say the sky is falling, here it is.  According to Black Book Market Research, more than half of the EMR vendors in business today are going to fail within the next few years.

Right now, according to Black Book estimates, there are almost a thousand EMR vendors in business, including over 600 smaller vendors. But by the time 2017 rolls around (or Meaningful Use 3 hits) more than half of those vendors will be gone, the research firm says.

To get a feeling for the state of the EMR market, Black Book surveyed 880 EMR consultants, analysts, managers and support team members. Ninety percent of those interviewed predicted that the majority of EMR vendors currently implemented will no longer exist as an independent entity. (They’ll either have merged, been acquired or closed up shop, the experts say.)

Eighty-eight percent of those interviewed believe that vendors who fail will have done so because they didn’t focus on usability, trying instead to turn out systems aimed at Meaningful Use compliance.

That being said, there does seem to be a path to continued independence and success for some vendors. Eighty-two percent of survey respondents believe that well-funded small vendors who carve out a strong niche in medical and surgical specialties — or serve buyers in alternative care settings — will  pick up market share during this period.

All told, these results are no surprise.

For example, it’s quickly becoming established wisdom that specialty EMRs are helpful and even necessary to specialist physicians.  EMRs that attempt to be “all things to all people” are increasingly losing favor with specialists, who want vendors that understand what they do and speak their language.

And the core message — that EMR vendors are going merge, be acquired or go belly up like crazy — is only common sense at this point.

My question is this: will vendors of general-use EMRs begin picking specialties and rolling out related products, or will the weaker all-purpose vendors cling to their model and go down with the ship?

CA Hospital Jettisons Nurse Communications Gear For iPhones

Posted on July 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.

At Keck Medical Center of USC, nurses will no longer use standard hospital communications gear.  In an effort to simplify and improve communications, the academic medical center is rolling out an initiative placing specialized adapted iPhones in the hands of each nurse.

According to an article in USC’s The Weekly, Keck’s IT leaders  have ordered 300 “specialty” iPhones for  use by the nursing staff. “The idea is to give them one device to do everything,” Keith  Paul, chief technology officer for USC Health Sciences, told The Weekly.

Paul chose to go with the iPhones when the firm installing its EMR said that they could link it with the smartphones. (The EMR is in the process of being rolled out, the paper reports.)

When the devices are completely functional, nurses will be able to receive secure messages from patients and other nurses, as well as emergency alerts, the article notes. The devices, which come with enhanced batteries and a tough casing, will also be able to show when a specific nurse is available.

Nurses are not going to be given their own phones, but instead, will pick up a phone at the start of their shift, entering their user ID and password to activate the device.  At the end of their shift, they’ll be asked to return the phones to a charging station.

One way in which the phones are unique is that they won’t have cellular capabilities. The modified iPhones will function only on the Keck campus, with calls made over the facility’s secure Internet infrastructure.

This is the first time I’ve heard about a smartphone or tablet rollout which crippled the cellular communications functions of the device, but it probably won’t be the last.

As we’ve previously reported, few smartphones are secure enough to meet even half of Meaningful Use or HIPAA requirements, according to ONCHIT. So it makes sense to run voice communications through a hospital-controlled voice-grade Internet network if you have the option (which Keck obviously did). But to date few hospitals (that I know of) have taken the plunge.

What’s equally interesting here is the extent to which the new iPhone rollout superceded investment in standard nurse communication platforms such as, say, Vocera phones. I wonder if vendors of such equipment will see iPhones or other smartphones begin to eat into their market share. What do you think?

Examples of Bad Hospital Workflows Meshing Poorly with EHR

Posted on July 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

In this LinkedIn discussion about California Nurses Slamming Sutter’s Epic EHR, Cameron Collette offers some of the best real life examples of hospital workflows causing issues with an EHR system. Carmeron’s comments are a great extension to my previous post about EHR implementation finger pointing. There are plenty of fingers to go around.

Much of the complaints I have witnessed come from a basic flawed work flow that has been going on in many hospitals for a long time. This can often be compounded by EMRs that allow high levels of customization… thus “gamming the system” becomes the tail of the day and issues come to the surface rapidly.

For example, I was in one hospital some time ago where ED physicians were placing the admit orders for the admit physicians. This created an electronic signing issue due to the fact that the system was not designed to account for the ordering doctor to be different from the actual admit doctor. And… the system was correct. The practice was incorrect.

I have also been to places where a good deal of care was handed to the nursing staff and even expected by the physicians. For example, in one facility I recall it was totally common place for a physician to write up to 35 PRN medication orders. This was done so that the physicians could avoid getting a call. Effectively this forced the nursing staff into clinical decision making where the physician should have been more involved. However, nursing complained that the system took too much time as they had to input “all of these orders”. Interesting point to me was that they did not complain about being put into a position where if something was to wrong with the patient, they were clearly the point of blame.

Each place is different, but more often than not a work flow issue is the underlying problem. There are two work flows to note. First, the EMR system has been configured, or worse, architecturally designed, poorly. Legacy systems are notorious for poor usability IMO. Second, actual real work work flows are not good practice or they are at best in need of some revamping.

It’s not US (EHR Vendor), it’s YOU (Hospital)

Posted on July 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

After reading Anne Zieger’s post about an Epic investment that promoted a CIOs departure, I engaged with @LukeDeanNif on Twitter where we discussed the challenge a CIO faces with any large EHR purchase.

Luke keenly observed that a CIO departure could happen with any EMR, not just Epic. Although, I think there’s a bigger challenge when it comes to Epic. Sure, we like to say that “No one ever gets fired for choosing Epic” (a takeoff from the IBM quote). However, that’s not always the case either. In fact, Epic has the perception of successful installs at big name institutions. If your hospitals runs into issues with your EMR implementation, many will question your organization and not Epic for why it’s failed.

You can already hear Epic people saying “We’ve successfully implemented this in XXXX organizations. This must be a problem with your organization.” That’s right, it couldn’t possibly be the EHR vendors fault. At least that’s the story that will be told. Given this, I guess you could say that in some ways it’s more risky for a hospital CIO to choose Epic over other hospital EHR vendors.

One thing Luke and I agreed on is that it’s really easy for an EHR vendor to point the finger at the hospital organization instead of taking responsibility for any issues that may occur. I’m not saying that hospitals are never to blame. In fact, hospitals can often take plenty of the blame for network issues, commitment issues, physician issues, or just plan organizational resistance to change. In fact, I’d say that almost every EHR implementation has a few of these things. The problem I have is that EHR vendors far too often point the finger at the hospital when there’s a problem and they forget about the 3 fingers pointing back at themselves.