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Database Linked With Hospital EMR To Encourage Drug Monitoring

Posted on March 31, 2017 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.

According to state officials, Colorado occupies the unenviable position of second worst in the US for prescription drug misuse, with more than 255,000 Coloradans misusing prescribed medications.

One way the state is fighting back is by running the Colorado Prescription Drug Monitoring Program which, like comparable efforts in other states, tracks prescriptions for controlled medications. Every regular business day, the state’s pharmacists upload prescription data for medications listed in Schedules II through V.

While this effort may have value, many physicians haven’t been using the database, largely because it can be difficult to access. In fact, historically physicians have been using the system only about 30 percent of the time when prescribing controlled substances, according to a story appearing in HealthLeaders Media.

As things stand, it can take physicians up to three minutes to access the data, given that they have to sign out of their EMR, visit the PDMP site, log in using separate credentials, click through to the right page, enter patient information and sort through possible matches before they got to the patient’s aggregated prescription history. Given the ugliness of this workflow, it’s no surprise that clinicians aren’t searching out PDMP data, especially if they don’t regard a patient as being at a high risk for drug abuse or diversion.

But perhaps taking some needless steps out of the process can make a difference, a theory which one of the state’s hospitals is testing. Colorado officials are hoping a new pilot program linking the PDMP database to an EMR will foster higher use of the data by physicians. The pilot, funded by a federal grant through the Bureau of Justice Assistance, connects the drug database directly to the University of Colorado Hospital’s Epic EMR.

The project began with a year-long building out phase, during which IT leaders created a gateway connecting the PDMP database and the Epic installation. Several months ago, the team followed up with a launch at the school of medicine’s emergency medicine department. Eventually, the PDMP database will be available in five EDs which have a combined total of 270,000 visits per year, HealthLeaders notes.

Under the pilot program, physicians can access the drug database with a single click, directly from within the Epic EMR system. Once the PDMP database was made available, the pilot brought physicians on board gradually, moving from evaluating their baseline use, giving clinicians raw data, giving them data using a risk-stratification tool and eventually requiring that they use the tool.

Researchers guiding the pilot are evaluating whether providers use the PDMP more and whether it has an impact on high-risk patients. Researchers will also analyze what happened to patients a year before, during and a year after their ED visits, using de-identified patient data.

It’s worth pointing out that people outside of Colorado are well aware of the PDMP access issue. In fact, the ONC has been paying fairly close attention to the problem of making PDMP data more accessible. That being said, the agency notes that integrating PDMPs with other health IT systems won’t come easily, given that no uniform standards exist for linking prescription drug data with health IT systems. ONC staffers have apparently been working to develop a standard approach for delivering PDMP data to EMRs, pharmacy systems and health information exchanges.

However, at present it looks like custom integration will be necessary. Perhaps pilots like this one will lead by example.

Half of Medication Errors Found In PA Study Involve HIT Issues

Posted on March 29, 2017 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 a Pennsylvania healthcare organization has found that computerized order entry systems and pharmacy systems were the most commonly reported factors contributing to medication errors in the state.

The Pennsylvania Patient Safety Authority, an independent agency tasked with finding and reducing the rate of medical errors in the state, recently released a report on medication errors reported to the agency during the first six months of last year. Under state law, Pennsylvania-based providers cutting across several categories, including hospitals, ambulatory surgical facilities and birthing centers, are required to disclose adverse events and “near misses” to the agency.

Between January 1 and June 30, 2016, the state’s healthcare facilities reported 889 medication-error events which cited health IT as a factor in the event(s). The errors most often reported were dose omission, wrong dose or overdosage and extra dosages, while CPOE and pharmacy systems-related problems were the most commonly reported health IT issues. (High-alert medications such as opioids, insulin and anticoagulants – which pose a higher risk of harm if misused – occupied three of the top five drug categories involved in most events.)

When they analyzed the data, agency analysts found that health IT-related errors took place during every step of the medication use process, and worse, most of those errors affected the patient directly, the data suggested.  And things may get worse before they improve. To hear agency officials tell it, HIT-related medication problems have become more common as health IT infrastructures have matured.

“As more healthcare organizations adopted EHRs and such systems became increasingly interoperable, the Authority observed an increase in reports of HIT-related events, particularly in relationship to medication errors,” said agency executive director Regina Hoffman in a prepared statement.

The Authority’s data doesn’t gibe completely with other research. For example, a report by the Leapfrog Group and Castlight Health notes that CPOE use has been very effective at reducing medication error rates. The report specifically refers to a CPOE study led by David Bates, MD, chief of general medicine at Brigham & Women’s Hospital, in which rates of serious medication errors fell by 88 percent during the period studied. Elsewhere, Leapfrog has cited studies in which CPOE use seems to have cut hospital lengths of stay, as well as major reductions in pharmacy, radiology and lab turnaround times.

On the other hand, the same report notes that CPOE systems still have a long way to go before they realize their potential. According to the 2015 Leapfrog Hospital Survey, hospitals’ CPOE systems failed to flag 39 percent of all potentially harmful drug orders, as well as 13 percent of potentially fatal orders. So it’s not a huge stretch to imagine that CPOE-using Pennsylvania hospitals are still having medication errors fall through the cracks.

It’s also worth pointing out that doctors don’t necessarily see CPOE systems as their best friend either. A study published last year in the Mayo Clinic Proceedings found that physicians who use EMRs and CPOE had lower satisfaction with time spent on clerical tasks and higher rates of burnout. Of course, given that the study lumps CPOE use in with EMR use, the results are somewhat skewed, but it’s still a data point worth considering.

Survey Data on the Healthcare IT Job Market

Posted on March 24, 2017 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.

I’ve been working for a number of years with Pivot Point Consulting, a Vaco Company (previously known as Greythorn) on their Health IT Market Report that looks at the Healthcare IT career space. This year they decided to do a trends edition that took this year’s survey results and compared it with historical data from the past three years which added a new layer of insight to the report.

While at the HIMSS conference, I had a chance to sit down with Ben Weber, Managing Partner, Pivot Point Consulting, a Vaco Company, to talk about their Health IT Market Report and the insights that were gleaned from their survey.

You can find my full video interview with Ben Weber at the bottom of this post or click on any of the links below to skip to a specific topic we discussed:

Be sure to download the full 2017 Healthcare IT Market Report: Trends Edition to dive into the responses to all the questions on the survey. Let us know in the comments what survey results stand out to you.

If you’re searching for a healthcare IT job, be sure to check out the jobs that Pivot Point Consulting has posted on Healthcare IT Central.

Who’s Over MACRA? CIO? COO?

Posted on March 22, 2017 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 no surprising way, MACRA is a major topic in pretty much every hospital and health system in the US. There’s a lot of money to be had or lost with MACRA. This is especially true for health systems with a lot of providers. Plus, it sets the foundation for the future as well. I believe MACRA will be as impactful as meaningful use, but without as many incentive payments (chew on that idea for a minute).

As I’ve talked to hundreds of organizations about MACRA, I’ve seen a whole array of responses for how they’re addressing MACRA and who is in charge. Is this a CIO responsibility since MACRA certainly requires EHR and other technology? Is this a COO job because MACRA is more of an operations problem than it is a technical problem? Some might make the case for the CMO/CMIO to be in charge since MACRA requires so much involvement from your providers.

From my experience, the decision usually comes down to choosing between the CIO and the COO, but with input and buy-in from the CMO/CMIO. How the CIO positions themselves will determine if they are over MACRA or not. Some CIOs see themselves as tech people and so they shy away from touching MACRA. Other CIOs see themselves as integral part of their business success and so they want to have MACRA under their purview. Most progressive CIOs that I talk to want the later.

I’m an advocate for a CIO that’s involved in the business side of things. Those CIOs that don’t want this duty are going to miss out on strategic opportunities for their organization. I heard one CIO describe that they viewed their IT organization as Information As A Service provider. Their job as the IT department was just to provide the information from the IT systems to someone else who would deal with the information, the MACRA regulations, etc.

The Information as a Service provider concept has issues on multiple levels. The most important is that if you’re just an information provider, then you lose out on the opportunity to be a strategic part of your organization. However, from a more practical MACRA level, it’s really challenging to provide the right information for MACRA when you’re just an information provider and know little about the regulation. We all know how quickly communication can break down when the person needing the information is disconnected from the people who provide the information and they’re disconnected from the people entering the information.

No doubt a healthcare CIO has to be careful what projects they add to their plate. However, I don’t think MACRA is one of those projects that should be pushed off to someone else. Certainly there can be specific organization cultures where it makes sense for the COO to run things, but I think that should be pretty rare.

How are you approaching MACRA at your organization? Who’s over it? I look forward to hearing your experiences in the comments.

Emergency Department Information Systems Market Fueled By Growing Patient Flow

Posted on March 20, 2017 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 research report has concluded that the size of the emergency department information systems market is expanding, driven by increasing patient flows. This dovetails with a report focused on 2016 data which also sees EDIS upgrades underway, though it points out that some hospital buyers don’t have the management support or a large enough budget to support the upgrade.

The more recent report, by Transparency Market Research, notes that ED traffic is being boosted by increases in the geriatric population, an increasing rate of accidents and overall population growth. In part to cope with this increase in patient flow, emergency departments are beginning to choose specialized, best-of-breed EDISs rather than less-differentiated electronic medical records systems, Transparency concludes.

Its analysis is supported by Black Book Research, whose 2016 report found that 69% of hospitals upgrading their existing EDIS are moving from enterprise EMR emergency models to freestanding platforms. Meanwhile, growing spending on healthcare and healthcare infrastructure is making the funds available to purchase EDIS platforms.

These factors are helping to fuel the emergence of robust EDIS market growth, according to Black Book. Its 2016 research, predicted that 35% of hospitals over 150 beds would replace their EDIS that year. Spurred by this spending, the US EDIS market should hit $420M, Black Book projects.

The most-popular EDIS features identified by Black Book include ease of use, reporting improvements, interoperability, physician productivity improvements, diagnosis enhancements and patient satisfaction, its research concluded.

All that being said, not all hospital leaders are well-informed about EDIS implementation and usability, which is holding growth back in some sectors. Also, high costs pose a barrier to adoption of these systems, according to Transparency.

Not only that, some hospital leaders don’t feel that it’s necessary to invest in an EDIS in addition to their enterprise EMR,. Black Book found. Thirty-nine percent of respondents to the 2016 study said that they were moderately or highly dissatisfied with their current EDIS, but 90% of the dissatisfied said they were being forced to rely on generic hospital-wide EMRs.

While all of this is interesting, it’s worth noting that EDIS investment is far from the biggest concern for hospital IT departments. According to a HIMSS survey on 2017 hospitals’ IT plans, top investment priorities include pharmacy technologies and EMR components.

Still, it appears that considering EDIS enhancements may be worth the trouble. For example, seventy-six percent of Black Book respondents implementing a replacement EDIS in Q2 2014 to Q1 2015 saw improved customer service outcomes attributed to the platform.

Also, 44% of hospitals over 200 beds implementing a replacement EDIS over the same period said that it reduced visit costs between 4% and 12%, the research firm found.

Against Medical Advice – ZDoggMD’s New Show

Posted on March 17, 2017 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.

For those of you reading this that don’t know ZDoggMD, what’s wrong with you? Seriously though, check out some ZDoggMD’s parody videos to see what I mean. Along with making “dope parody videos”, he has just started live streaming a new show he called Against Medical Advice which he streams live each week on the ZDoggMD Facebook page.

Check out the trailer for Against Medical Advice:

I love the goals that ZDoggMD has for the show and he’s such a unique talent so check it out. Against Medical Advice episode 1 and episode 2 are out if you want to see something you’ve never seen in healthcare.

If you’re not a fan of his new show, you’ll probably enjoy this heartfelt parody of 7 Years (A Life in Medicine). It’s a good reminder of the importance of the work we’re doing in healthcare.

Hospital App Helps Patients After Surgery

Posted on March 15, 2017 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.

Patients are very vulnerable after surgery. If they don’t follow post-surgical instructions, they may be readmitted (never a good thing for hospitals these days), and far worse, may suffer real harm.

Unfortunately, many patients don’t retain or follow doctors’ instructions on how to best recover from surgery, particularly if these instructions aren’t documented well.  For example, a 2015 study appearing in Anesthesiology concluded that only 60% of 519 surgery patients who got verbal post-operative instructions or annotated EMR records complied with medication instructions.

In an effort to improve stats like these, Chicago’s Rush University Medical Center has introduced an app designed to support patients in their post-surgical recovery process. The app, SeamlessMD, prompts patients to ask for reminders about their surgeon’s instructions, according to a HIMSS Future Care article.

Anthony Perry, MD, vice president for ambulatory care and population health at Rush, told the publication that his facility had already implemented protocols for enhanced recovery after surgery before the app was created. But the app has potential to move patients’ post-surgical recovery to the next level, Perry said. “It’s not only a neat technology, but a neat technology that’s truly aligned with our own goals,” he noted.

Dr. Perry believes that presenting prompts and reminders via a personal mobile device offers benefits traditional care instructions can’t, particularly when the app is placed on a patient’s phone. “There’s a bridge that a smartphone gives us into a person’s everyday life that we don’t have when they come visit us in the office,” he said.

Rush’s initiative comes as hospitals around the world consider the benefits of rolling out patient-oriented apps. For example, four National Health Services hospitals serving the United Kingdom are testing apps that monitor patient health at home.

The hospitals are testing two apps, one focused on managing gestational diabetes treatment and the other addressing COPD monitoring and care. (As one might expect, the diabetes app collects blood glucose readings and the COPD app oxygen saturation levels.) The pilot, which is still in its initial stages, has already seen some success. For example, the number of office visits by patients with gestational diabetes has fallen 25% since the app was released to such patients.

This may be the dawn of a new age for hospital use of mHealth apps, which has been at best at a trial-and-error stage for several years. While most hospitals and health systems have toyed with apps to some degree, in the past there was neither a clinical nor technical approach for them to adopt. So many initial app projects went nowhere.

But with evidence piling up that at least some approaches work – such as remote patient monitoring for chronic disease management, as described above – hospitals are beginning to see apps as a practical tool for improving outcomes. Meanwhile, as they’ve adopted mobile-friendly infrastructures, hospitals have become more capable of supporting hospital-developed apps effectively.

Of course, there’s probably a number of functions apps can perform which nobody’s pursued just yet. But with some early successes in place, my guess is that hospitals will try lots of new app projects going forward.

ACOs Not Scaling Well, But Health IT Helps

Posted on March 13, 2017 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.

ACOs were billed as the next big thing in healthcare, a model which would create economies of scale and tame rising costs of care. In theory, unifying hospitals and doctors into an overarching entity – and creating shared clinical and financial goals – should improve care and boost efficiency.

Of course, creating them doesn’t come cheap. In fact, creating even a modest ACO typically calls for between $1 million and $3 million in capital investment, according to Michael Deegan, MD, who recently developed a course on ACOs for the University of Texas at Dallas. It also takes 18 to 24 months to launch an ACO, Deegan told an interviewer at UT.

But once all of the Ts have been crossed and the Is dotted, ACOs can meet their stated goals, right? Actually, not so much, though health IT can help things along, according to Indranil Bardham, a colleague of Deegan’s at UT Dallas who serves as professor of information systems.

According to an article in HealthcareITNews, Bardhan recently completed a study on ACO performance which concluded that health IT had a measurable impact on their efficiency. The study, which drew on 2013-2015 data from CMS, reviewed the performance of 400 ACOs.

Among the key takeways Bardhan took from his research was that the larger an ACO was, the more likely it was to be inefficient. This flies in the face of conventional wisdom, which would suggest that bigger is better when it comes to improving efficiency.

On the other hand, health IT use had the effect its champions might hope for, though modest in scope. The study concluded that a 1 percent increase in HIT usage was associated with an 0.5 percent increase in ACO efficiency.

The thing is, these measures represent just a couple of ways to evaluate ACO performance, making it hard to tell just what is working, Bardhan told HIN. “Healthcare, with respect to ACOs, is fascinating because there is not just one single output measure that you are using to compare performance,” he told the magazine’s Bill Siwicki. “…It is difficult to measure the performance of organizations against each other when you have multiple outputs that cannot easily be transformed into a single dollar number.”

This squares with commentary by other ACO researchers, who seem to agree that the whole ACO evaluation process is a bit mysterious. As health policy analyst David Introcaso notes, in a review of ACO-based Medicare Shared Savings Program, CMS isn’t helping either. “While CMS details financial and quality performance results, the agency does not explain, at least publicly, how results, favorable or unfavorable, were achieved.”

Without knowing more about what we should measure, and why – much less what steps helped in achieving their results – it’s too soon to tell what type of health IT should be deployed in ACOs. But looked at more optimistically, once we have a better idea of what ACO success factors are, it seems likely that health IT tools will help execs address them. (For a look at one completely health IT-based ACO concept, see this piece on the Virtual ACO.)

The B2B Vendors are Coming! The B2B Vendors are Coming!

Posted on March 10, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

It’s been a couple of weeks since the annual HIMSS conference wrapped up for 2017 and I’m just starting to emerge from the HIMSS-Haze of sleep deprivation. I doff my hat to those that recovered more quickly.

As usual there was too much to take in at HIMSS17. The keynotes were fantastic, the sessions educational and the exhibit hall had a buzz about it that was absent from last year’s event. Although the main take-away from HIMSS17 seems to be the emergence of Artificial Intelligence, I believe something else emerged from the event – something that may have far greater ramifications for HealthIT in the short term.

For me the big story at HIMSS17 was the arrival of mainstream IT companies. I have been going to HIMSS for 10 years now and I can honestly say this year was the first time that non-traditional healthcare IT vendors were a noticeable force. SAP, IBM (Watson), Intel, Google, Salesforce, Samsung and Microsoft were just a few of the B2B vendors who had large booths in the HIMSS17 exhibit hall.

Salesforce was particularly noteworthy. They made a big splash with their super-sized booth this year. It was easily five times the size of the one they had at HIMSS16 and featured a fun “cloud viewer” at its center along with a large theatre for demonstrations.

Salesforce, however, didn’t stop there. They also threw a HUGE party over at Pointe Orlando on Tuesday night. At one point, the party had a line of eager attendees that snaked out the front of the facility. Their party rivaled that of several large EHR vendors.

IBM was also back at HIMSS after an extended absence. Their “organic booth” was always busy with people curious to learn more about IBM Watson – particularly after the keynote given by CEO Ginni Rometty on Day 1.

So what does the arrival of mainstream B2B vendors mean for healthcare?

Consolidation. The EHR gold rush is over and yet companies like SAP and Salesforce are still electing to invest in healthcare. Why would they do that at a time when government incentive money has all but dried up? I believe it’s because they smell consolidation and optimization opportunities. These B2B players have large war chests and as HealthIT companies begin to struggle, they will be knights in shining armor waiting to swoop in.

More Consumer Technologies. One of the big trends in healthcare right now is consumerism. There is a drive by healthcare organizations to adopt consumer-centric technologies and workflows to service patients better. Patients are seeking providers that offer the conveniences that they are used to as consumers: online appointment booking, mobile chat, real-time price quotes, etc. Companies like Google, Samsung, IBM and Microsoft already have technologies that work well in the consumer world. With growing demand in healthcare it’s only natural that they are investing.

Standards. Maybe I’m just being optimistic, but when companies like TSYS (a very large financial transaction processor) show up at HIMSS for the first time, one can only hope that standards and interoperability will soon follow. After all, if cut-throat banks can agree on a common way to share information with each other, surely the same can happen in healthcare.

Cognitive Computing. Google, IBM, Microsoft and Intel have all made big bets on cognitive computing. I’m willing to bet that their investments in this area dwarf anything that a HealthIT company has made – including Epic and Cerner. IBM and Microsoft in particular have been aggressively seeking partners to work with them on health applications for Artificial Intelligence. Just ahead of HIMSS17, Microsoft and UPMC Enterprises announced that they would be working together to “create new products aimed at transforming care delivery”.

I’m very excited by the arrival of these B2B technology vendors. I think it signals the start of a maturation phase in the HealthIT industry, one in which consolidation and collaboration break down legacy silos. At the very least, traditional HealthIT companies like Cerner, Epic, athenahealth and NextGen will now have to step up their game in order to fend off these large, well-funded entrants.

Exciting times!