ONC Releases HIE Toolkit For Rural Healthcare

The ONC has released a new toolkit designed to help rural healthcare players such as rural hospitals, critical access hospitals, clinics and state offices of rural health to participate in HIEs, iHealthBeat reports.

Here’s a summary of what the toolkit contains, courtesy of iHealthBeat:

• A guide — titled, “Health Information Exchange-First Considerations” — which covers the first steps in establishing or joining a health data exchange
• A spreadsheet — called the “ROI Calculator” — which helps determine possible costs and savings associated with implementing electronic health record systems and health information exchanges
• A guide — titled, “HIE Direct Guide” — which aims to help health care providers understand and implement data exchange using protocols from the federally developed Direct Project
• A tool — titled, “HIE Policy Matrix” — which includes policy recommendations adapted from the Connecting for Health Common Framework
• A guide — titled, “Privacy and Security Overview and Resource List” — which details privacy and security requirements for data exchanges

The toolkit release follows on ONC head Farzad Mostashari’s announcement that this will be the year providers are pushed hard to go for interoperability.

Expect to see more efforts of this kind as ONC nobly soldiers along, suffering from a trimmed budget due to sequestration, attempting to close the gaps vendors seem loathe to close.

Yes, as Mostashari notes in an interview with HealthcareITNews, Meaningful Use Stage 2 pushes the vendors a long way toward interoperability:

Vendors are really going to have to step up to the plate in terms of being able to achieve the Stage 2 expectations for true vendor-to-vendor coded, clinical structured, documents being able to have kind of ubiquitous protocols with security in place. That’s a big step for the industry and meaningful use Stage 2 sets the tempo and expectations for that.

But vendors have proved amazingly agile at wiggling out of interoperability promises to date. Let’s see if MU Stage 2 finally breaks the deadlock.

HIMSS: Hospitals Achieving Meaningful Use Milestones

Hospitals are making good progress toward achieving Meaningful Use milestones, a new study by HIMSS suggests.

HIMSS, which surveyed 298 healthcare CIOs between December and February, found that 66 percent had already qualified for Meaningful Use stage 1, while another 4 percent expected to do so before the end of 2012, Information Week reports.

Meanwhile, 75 percent of respondents said they expect to attest for stage 2 in 2014, which  as readers probably know is the first year of stage two attestations.

Given the ambitions noted by the CIOs, it’s not surprising to learn that 66 percent of them said they thought their budgets would definitely or probably increase this year.  Of the remainder, 15 percent said their budgets would remain level, and 8 percent expected to see a decrease.

Last year, achieving Meaningful Use was the hospital CIOs’ top business objective, named by 24 percent of respondents, but this year, it fell to 15 percent. This year, the top health IT business objective has switched over to survival, with 21 percent saying their key goal was to sustain the financial viability of their organizations.  This was followed closely by improving patient care, which came in at 19 percent.

Still, Meaningful  Use will obviously stay top of mind for the CIOs, who may be better prepared than last year but still have much to handle.

After all, they expect to make serious money on achieving MU goals, HIMSS concluded. The survey found that about 30 percent of hospital CIOs expected an ROI of up to $2 million on stage 1, another 23 percent a return of $2 million to $3 million, and 16 percent expected ROI of $4 million to $5 million.

Homecare Firm Dispatches 4,000 Android Tablets With Nurses

Could Android gear be sneaking up on Apple? Here’s one case where a national healthcare organization decided to go with the Android technology for a very large and clearly mission-critical purchase.

A national homecare agency has bucked the iPad trend in tablets, picking up 4,000 Android-based units to send with its personnel to patient homes. The company, Philadelphia-based Bayada, issued the Samsung 7-inch Galaxy Tab 7.0 plus to its therapists, medical social workers and other home health professionals.

In issuing the tablets, Bayada hoped to make its homecare professionals more efficient, especially when visiting Medicare home health patients who only get one hour each.

The tablet deployment followed a 20-person pilot in which it found that the typical nurse reduced his or her typing by one-half hour every day if using a tablet during visits instead of paper or a laptop.

Not only do workers use the tablets to document care within patient homes, they also pull up patient data before they head out on their patient visits.  This spares the nurses having to report to a central office to get their appointments before they leave in the morning.

To make clinical data entry simpler, Bayada has loaded the tablets with SwiftKey Healthcare’s keyboard software, an app which is preloaded with medical terms. It uses artificial intelligence to anticipate which words will be typed next and “learns” over time what words healthcare workers use most often.

Since implementing the SwiftKey software, 69 percent of Bayada’s nurses said they preferred using a tablet for taking clinical notes.

Given the large price difference between the iPad/iPad mini and Android tablets — with Android, obviously, at a lower price point — I’d be surprised if other large healthcare organizations didn’t follow in Bayada’s footsteps.

After all, Apple fan though I am, I have to admit that as the suite of apps available for the Android platform matures, there’s less and less reason for institutions to pay the premium Apple demands.  I wonder if we’re seeing the beginning of a major shift in Android investment by healthcare organizations.

Physicians Like EMR-Connected Apps

A new survey by vendor eClinicalWorks has concluded that the vast majority of physicians like EMR-connected apps, and many cases, believe that apps can improve patient care.

Of course, the research is a bit self-serving. The study announcement comes alongside news that the company plans to invest $25 million on patient engagement tools over the next 12 months, starting with a free mobile app for patients available on iOS and Android. Still, it’s worth a look anyway.

The study, conducted online, collected responses from 2,291 healthcare professionals in mid-January, reports SearchHealthIT.com.  Of that total, 649 respondents were physicians.

Researchers found that nearly all doctors responding (93 percent) think it’s valuable to have a mobile health app connected to an EMR, the site reports.  The same number of doctors said that mobile health apps can improve a patient’s health outcome, and 80 percent said they were likely to recommend a mobile health app to a patient.

So what do physicians hope to gain from such apps, specifically?  According to SearchHealthIT.com:

* 58 percent of physicians were particularly interested in the ability to provider automatic appointment alerts and reminders. (Six out of ten physicians said that at least half their patients would like getting appointment reminders from an app, too.)
* Almost half of doctors felt giving patients access to their medical records was a key benefit
* Many suggested that using apps to make appointment scheduling easier would be very helpful

The study also concluded that apps could help with patient wellness. Sixty-five percent said they could improve medication adherence, 54 percent diabetes care and 52 percent preventative care, the site reported.

EMR Issues To Address In 2013

So, we’re coming up on 2013, dragging many of the issues that dogged 2012 right along with us.  My theory is that many of the following are likely to linger through next  year as well, though maybe I’m being too cynical.

Here’s my list of ongoing EMR issues that don’t seem to be going away:

* Usability problems:  While there are scattered efforts to improve the entire EMR usability model, none rules the industry. So as things stand, clinicians generally dislike (or, let’s admit it, in many cases loathe ) enterprise EMRs hospitals have mortgaged their future to buy.

* Interoperability:  With proprietary Epic software ruling a growing percentage of U.S. hospitals, getting true interoperability that fuels HIE growth seems a mere dream at the moment. And even if Epic and it’s “ours is best” philosophy didn’t rule the waves of late, connecting other hospital EMR vendors is at a primitive stage at best.

* Poor compatibility with popular mobile devices:  Far too few vendors offer a mobile-native client for their EMR, instead forcing clinicians to cope with the limitations of Citrix compatibility. This state of affairs is terrible for the growth of mHealth, which I think we can agree is a Bad Thing.

* Extremely high cost for enterprise EMR systems: When you’re talking about enterprise software, you’re generally talking about a large price tag. But am  I the only one who thinks that vendors are padding the heck out of their prices because Meaningful Use has hospitals under the gun?

* Lack of documented ROI and clinical improvement generated by EMRs:  Other than collecting an incentive check, most hospitals don’t seem to know how their EMR will generate money, much less savings or return on investment.  And as for a body of well-documented research demonstrating that EMRs can generate better clinical results, we just aren’t there yet.

What other problems do we face this year that are going to remain tough to fix next year? Are any of these problems on the verge of being solved?

Health IT Stands Out In Health Technology Hazards List

The ECRI Institute has just released its annual list of top 10 health technology hazards, and this year, two of the hazards are health IT related. This probably isn’t a surprise to anyone who reads this blog, but it’s still worth noting, as it’s easy to get embroiled in abstract IT discussions and forget concrete patient risks, wouldn’t you agree?

For context, here’s ECRI’s list for 2013 in its entirety:

1.  Alarm hazards
2.  Medication administration errors using infusion pumps
3.  Unnecessary radiation exposures and radiation burns
during diagnostic radiology procedures
4.  Patient/data mismatches in EHRs and other health IT
(HIT) systems
5.  Interoperability failures with medical devices and health
IT systems
6.  Air embolism hazards
7.  Inattention to the needs of pediatric patients when using “adult”
techniques
8.  Inadequate reprocessing of endoscopic devices and surgical
instruments
9.  Caregiver distractions from smartphones and
other mobile devices
10. Surgical fires

As you can see, two of the top five are EMR-related, and perhaps more importantly, are risks that don’t get discussed that often in health IT watering holes such as this publication.  But it’s hard to argue that patient/data mismatches could pose severe risks up to including death, as could interoperability problems between medical devices and healtlh IT systems.

While ECRI doesn’t, I’d also count number nine, mobile device distractions, as I’m betting much of the distraction clinicians face comes from clinical communication, not idle chatter.  And while I don’t know how ECRI ranks its choices, I’d bet it actually belongs higher on the list.

I’m not going to sound like much of a prophet when I predict that health IT  problems will take over more slots on the list over time.  For example, when infusion pumps are linked with EMRs, interchange of data will almost certainly become a life or death issue.

In the mean time, dealing with mobile device distraction may be the lowest hanging fruit of the bunch. I don’t know how to do it, but if a vendor comes up with a solution that elegantly streamlines doctor communication on mobile devices, it’s likely to be a big hit.

Study: EMR ROI Stronger In Low-Income Setting

Well,  here’s some information which caught my eye right away. According to a new study published recently in the Journal of the American Medical Informatics Association, EMRs can provide a good return on investment for hospitals located in low-income areas.

In the study, researchers studied the what happened when a tertiary hospital in Malawi implemented an enterprise- wide EMR system.  The felt it was important to evaluate an EMR implementation in a low-income area such as this, the authors noted, because such hospitals face obstacles unlike those in more prosperous areas, such as marked supply and staff shortages, which might change the effect of such a system.

To examine the impact of the EMR, researchers looked at three areas: length of stay at the facility, transcription times and lab use.  The hospital saved an estimated $284,395 per year in U.S. dollars. By the third year of operation, the EMR  started generating a positive ROI, and by five years, it provided net benefit of $613,681, according to FierceEMR.

This is an inspiring study for those who hope to see EMR success stories, as until recently, there’s been little if any information to suggest that EMRs can offer a substantial savings on operations, much less help to generate a profit.

This doesn’t necessarily mean that hospitals aren’t generating savings or even profits by implementing an EMR.  As we noted in a previous story, few hospitals are planning for and implementing EMR ROI measures early in the game, according to a recent study from Beacon Partners.

If hospitals don’t dig in and integrate EMR ROI measurements into their strategic planning, it’s not surprising that they aren’t getting the fullest picture of what their systems are delivering. Backward-looking measurements aren’t likely to do as much as measurements built on a hospital’ls entire vision for success. Let’s see what happens when hospitals focus on ROI as a top-of-mind item going forward.

Hospitals Behind On EMR ROI Measurements

Buying an EMR is one of biggest investments a hospital IT department is likely to make. To date, however, few hospitals are planning for and implementing EMR ROI measures early in the game, according to a new study from Beacon Partners.

Beacon interviewed more than 300 healthcare leaders about the clinical system performance measures they used for their EMR, as well as the resulting ROI.  What researchers found out was that most respondents weren’t happy with their organization’s attempts to measure the ROI on their EMR spend — and that many hospitals aren’t directly measuring ROI at all.

According to healthcare leaders who spoke with Beacon, quality management and IT departments, rather than financial executives,  generally institute EMR performance measures. All told, 40 percent of respondents said that they were using performance measures, but only 36 percent were satisfied with the extent to which the data was being used to measure the value EMRs brought to their organization, Beacon reports.

The problem may spring from a lack of planning. According to Beacon’s respondents, less than half (48 percent) of performance measures are determined during planning.  In fact, 32 percent of providers said that performance measures were implemented in at least one patient care area post-EMR implementation.  Fifty-one percent of respondents said that they would have preferred to implement clinical system performance measures earlier than they had done so.

It’s hard to tell what would deter these healthcare execs —  mostly leaders with community hospitals — from demanding more results from their EMR investment. My best guess, though, is that adhering to Meaningful Use guidelines has taken up all of their bandwidth, and that CFOs have been mollified by the promise of incentive payments from the feds.

As the Beacon study suggests, though, healthcare leaders aren’t satisfied with this state of affairs. Vendors, expect to get more searching questions about ROI measurement over the next year or two.

Study Suggests Most HIEs Aren’t Sustainable

According to an EHR Intelligence piece, most HIEs spend more than $1 million per year on operational expenses. That number is probably well on the low end for regional HIEs with multiple health system partners. All told, I think we can agree we’re talking about a money pit here.

The question is, and has been for many years, whether those investments offer any financial or clinical payback. After all, you can only lay out that kind of money for so long before there’s no business case for the exchange.

Unfortunately, it looks  like the answer may still be “no” in many cases, according to the authors of a study appearing in Perspectives in Health Information Management.   Of the 96 HIEs that responded to the researchers’ survey, the “vast majority” didn’t have a business model in place that would sustain itself even into the near future.

What’s worse, there’s little evidence that things are due to change anytime soon, the authors write:   “The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level.”

Even more troubling is the apparently lack of insight into this state of affairs by HIE leaders, the authors assert.  When asked how they measured ROI, the authors apparently got very squishy answers, such as that they “believed” their HIE was showing positive ROI without having any metrics to make this case.

I don’t know about you, readers, but I’ve been following health data exchanges of various kinds since the early 1990s, and this is just depressing. If the government’s strategy in doling out some HITECH dollars to HIEs was to help build the core of the Nationwide Health Information Network, I think it’s pretty much proving to be a bust.

No, I’ll come out and say it:  I think the government ought to pour massive funding into building out the NHIN and just get it over with without waiting for the politics and competing priorities of healthcare to gum up the works. At this point, I doubt anything else CAN work.

Epic EMR ROI

I think we are familiar with the HUGE institutions that have selected Epic. The most famous of these is the Kaiser implementation of Epic which started at $1.2 Billion and was projected to cost $4 Billion. Yes, that is Billion with a capital B for an EHR implementation. I haven’t done any in depth research on the average cost of an Epic installation, but I can’t remember seeing one lower than a few hundred million at the least.

As I consider these numbers, the following question keeps nagging at me: What’s the ROI for an Epic installation?

Don’t get me wrong. I already know about the many EMR benefits. Although, billions or even hundreds of millions of dollars is a lot of money to make up.

The problem is that covering the EMR space as long as I have, I have yet to see someone do a ROI analysis of an Epic installation. If there’s one out there that I don’t know about, I’d love to take a look. Maybe Epic has some, but it’s part of their tightly controlled process for selling their EHR. Although, if the ROI was so good, it makes you wonder why they wouldn’t want that information in the public domain.

A part of me wonders if hospital CIO’s really care about the ROI of an Epic EHR install. Epic seems to be similar to what enterprises use to say about IBM: “Nobody ever gets fired for buying IBM.” Do many hospital CIOs see it as “Nobody ever gets fired that buys Epic”?