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Epic Module Targets Patients For Care Coordination

At Gundersen Lutheran Health System, executives have put together a program to target the 1 to 2 percent of those most likely to be hospitalized, seen in the emergency department or face other complications. To manage the program, the La Crosse, Wis.-based system is leveraging a feature of their Epic EMR which sifts out the patients most in need of additional care coordination, reports Health Data Management.

Gundersen Lutheran is targeting complex patients with its program, but not just those with medically-complex conditions. They’re also hoping to find patients who, while they might have simpler conditions, live alone or have trouble following sometimes difficult medical care plans.  The system is using the EMR first to identify the patients, then to treat them, according to Health Data Management.

To find patients in need of extra care coordination services, Gundersen is using a “tiered scoring” module built in to the Epic platform which includes one component for medical complexity and another to measure psycho-social issues. When clinicians want to refer a patient to the care coordination program, physicians use the Epic scoring tool to see if  the patient qualifies. Clinicians can also notify the care coordination team using the Epic system, in three clicks or less, noted Beth Smith, R.N., executive director of patient and family-centered care at the health system.

The patients identified by the scoring model as in need of extra care coordination are farmed out to a group of 22 nurses and social workers, whose job it is to monitor the care of these complex patients who are more likely to face adverse events.

The workload the care coordinators face is intense.  Typically, care managers are supervising some 1,700 patients each, who not only stay in touch with patients but also attend office visits and follow through with specialists.  Epic plays a role here too, however.  Care coordinators get a special tab in the Epic EMR which pulls key elements of the patient’s history into a single view,  making it easier to get a sense of the whole patient.  Epic also notifies them via a message in the system if a patient shows up in the ED.

According to Health Data Management, this program has helped stabilize hypertensive and diabetic patients, with just under half showing sustained improvements over a two-year period.

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May 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Clinical Decision Support  Hospital EHR  Hospital EHR Company  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital Healthcare IT
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Hospital Vs. Clinic EMRs: Key Differences

In some ways, hospital and clinic EMRs have the same job to get done — to assess, test and treat patients. But they do have to be optimized differently, as hospitals and clinics do things at a different pace and of necessity are organized differently.

Here’s some of those differences, courtesy of TELUS Health’s Shawn Vincent:

*  Difference number one:  Minutes count

Hospitals care for patients in acute situations, where minutes or even seconds can determine the patient’s outcome.  In medical practices, “care is measured in weeks, not hours,” Vincent notes.

Result:  Hospitals need test results immediately, where clinic patients can wait until their next visit days or weeks later.

* Difference number two:  Patient departures

In hospitals, patients consume resources until discharge, and that doesn’t happen when tests and treatments are still outstanding.  In clinics, patients can leave while tests are outstanding or treatment results are still pending.

Result:  Hospitals must perform well at “round trip” test and treatment management.

* Difference number three: Who runs the show?

Hospitals are generally run by a large corps of professional leaders, including boards of directors, business expects, lawyers and many other stakeholders.  Medical practices, traditionally, owned by doctors who practice there, and are responsible for care, documentation, and ultimately, liability for all that takes place.

Result:  Hospitals usually have tough rules in place about how medicine can be practiced, and also how it is documented, which roll down to everything from how the EMR user interface looks to how events are audited. In clinics, doctors make their own rules.

* Difference number four: Short vs. long-Term Care

Hospital encounters usually call for just enough information to treat the patient — more can be a distraction which slows down care.  In medical practices, on the other hand,  having longitudinal data on the patient is central to caring for them over the years.

Result:  Hospital IT systems must be artfully designed to display “just enough information to make a meaningful medical decision without distracting the user with unnecessary details,” he notes.

Readers, what other differences between hospital and medical practice EMRs do you consider to be important?

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May 14, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Community Hospitals  Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Hospital IT Systems
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Cleveland Clinic Brings Epic Smarts To NY Hospital Practices

The Cleveland Clinic is going the consulting route, this time around by working with the physician and specialty practices for a New York hospital to bring Epic up to speed.

Glens Falls is a 410-bed nonprofit which began implementing the Epic EMR in early 2012. The New York facility has 3,000 employees and 28 regional locations.

Apparently dissatisfied with its internal knowledge base on the subject, It’s now contracted with the Clinic’s MyPractice Healthcare Solutions (MPHS) to help deploy and optimize its rollout, reports the Cleveland Plain Dealer.

Among the Epic products installed at Glens Falls is “MyChart,” offering a clinical and billing records portal for patients, according to the Plain Dealer.

The Cleveland Clinic has had Epic in place for more than 10 years, making it one of the first healthcare systems in the country to install the vendor’s product. Having learned from that experience, Cleveland Clinic MPHS now brings project management and implementation expertise to other facilities.

I think this is an interesting business model for the Cleveland Clinic, and I’d be curious to see what other consulting agreements it has put into place. (So far I wasn’t able to turn up any others but my guess is that they exist.)

It seems to me that hospitals who have tamed Epic — Kaiser Permanente comes to mind — might very well go into this line of business, as the need is great. Not to mention that if I were making a decision as to who I’d hire to wire my medical practice into my hospital, a successful institution would have a very strong pitch to make.

Can any of you readers share other examples of hospitals/clinics who are turning their Epic experience into a consulting revenue stream?

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May 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Community Hospitals  Hospital EHR  Hospital EHR Company  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital EMR Vendor  Hospital Healthcare IT  Hospital IT Systems
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Many Hospital Executives Expect Big Health IT Investments This Year

Surprise, surprise.  A new report from the Premier healthcare alliance finds that many hospital executives will make their largest capital investments in IT this year.

To prepare the report, known as the spring 2013 Economic Outlook, Premier spoke with 530 survey respondents, most of whom were hospital leaders.  Survey respondents also included materials and practice area managers, reports iHealthBeat.

Roughly 43 percent of respondents said that their health organization’s biggest capital investment over the next year would be in health IT, a jump of 21 percent from two years ago.  Offering a hint on where the money may be going, the report also found that 32 percent of respondents can’t currently share data across the continuum of care.

Other clues as to where the spending is going come from the study’s topline finding, which predicts a big shift from inpatient to outpatient care.

According to Premier, only 35 percent of respondents are expecting to see an increase in inpatient spending this year as compared to 2012, down 30 percent from predictions made last year. Meanwhile, 69 percent of respondents said they expect to see an increase in 2013 outpatient volume compared to last year.

Some additional intelligence from the report:

* 22 percent of respondents are in an ACO, and 55 percent plan to be by the end of next year

* 27 percent don’t have plans to pursue the ACO model, and may look to bundled payment, care management fees or pay for  performance options

*  29 percent said overutilization of products and services and 22 percent said lack of clinical coordination were the biggest drivers of healthcare costs

* 48 percent said reimbursement cuts had the biggest impact on their health systems

* 40 percent said capital spending would increase over the next 12 months as compared with the previous year

* Almost 37 percent project a capital spending decrease

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May 8, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Healthcare CIO  Hospital CIO  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Hospital IT Budget  IDN  Mid-Size Hospitals
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W. VA. Rolls Out Enhancements To VistA

Officials with the West Virginia bureau of behavior health and health facilities are putting some finishing touches on VistA installations cutting across the state, adding computerized laboratory information to a six-year-old implementation.

West Virginia officials have implemented Vista in seven communities, Modern Healthcare reports. Facilities include an acute-care hospital, two psychiatric hospitals, four long-term care hospitals, a nursing home and two ambulatory care clinics.  The facilities are all connected to a central database in Charleston via T1 lines.

The state has been working on contract with Medsphere Systems Corp. to install a VistA version known as FOIA VistA, a version in the public domain that can be obtained freely from the VA under the Freedom of Information Act, Modern Healthcare notes.

Though VistA itself is free, the state has spent heavily on installing it across the seven sites.  Since FY 2005, West Virginia has paid Medsphere $8.4 million for system implementation, development and support, and is contracted to pay the vendor $939,800 this year for support.

In addition to paying Medsphere a monthly fee for systems support, the state pays licensing fees to InterSystems, developer of Cache, a version of the MUMPS database and programming language. It also licenses Keane’s financial system, which interfaces with VistA.

West Virginia began looking at a common infrastructure for all of its facilities when HIPAA passed back in 1996, noting that the idea behind it was portability and accountability. Now state officials are glad they moved ahead. “It’s expensive,” but “in terms of satisfaction, I think we’d all agree it was well worth it,” deputy commissioner for administration Craig Richards told the magazine.

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May 7, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Community Hospitals  Hospital EHR  Hospital EHR Company  Hospital EHR Consulting  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital Healthcare IT  Hospital IT Systems
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Epic Installation Fuels Maine Controversy

Ordinarily, the fact that integrated delivery system MaineHealth had spent $150 million on an Epic EMR system wouldn’t excite a lot of comment.  After all, say what you like about Epic, it doesn’t come cheaply, and a $150 million install is at the low-ish end of what hospitals are spending to put the vendor’s system in place.

This time, though, the health system is taking fire from the community, in part because it’s decided to close 22-bed St. Andrews Hospital in Boothbay Harbor, reports EHR Intelligence. 

In an open letter published in the Boothbay Register, local selectman and St. Andrews Regional Task Force member Stuart Smith argues that the Epic install cost is “extremely high.”

Smith also notes that Maine Health has had a bad time with the installation, which was supposed to go live on December 1, 2012 and now looks as though it won’t go live until 2015.  As Smith sees it, a lot of money and time is being wasted on the Epic project:

Millions of dollars have been charged to member hospitals and staff time (salaries and mileage) over the past 2–3 years with no benefit. The system failure also adds operational costs going forward that were not planned for and regional consolidation of finance will now be delayed.

As things stand, Smith notes, the planned closure of St. Andrews is part of a larger shuffle moving urgent and emergency services around which has led to roughly $2 million in losses for the facility.

With St. Andrews wobbly, leaders are considering merging it with struggling Miles Memorial Hospital, a combination which could allow its owners to keep $5 million in federal reimbursement by keeping its critical access hospital designation.

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May 6, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Community Hospitals  Critical Access Hospitals  Hospital EHR  Hospital EHR Company  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital Healthcare IT  Hospital IT Systems  IDN
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Survey: Confusion Slowing Meaningful Use Compliance

While Meaningful Use is likely to spur improvements in health IT, confusion over regulations — and the need to pursue other pressing HIT projects — are slowing down MU compliance, according to a new study.

The survey was conducted by Stoltenberg Consulting, which spoke with health IT managers, clinicians, HIT vendors and government agencies that attended this year’s HIMSS event.

Researchers asked which areas in which HIT will achieve the biggest improvements over the next 12 months.  The biggest group (35 percent) named Meaningful Use, while 19 percent said health information exchange, clinical integration and mobile health were due for the most growth.

When asked what might hold them back from meeting Meaningful Use requirements, 29 percent said confusion and/or ambiguity in the regulations were a challenge. Others named competing health IT projects (23 percent) and a lack of key resources such as funding, IT skills, talent and time (17 percent).

The survey also asked respondents what issues were likely to dominate HIT discussions this year.  Respondents favored health information exchange (62 percent), followed closely by mobile health (58 percent) and clinical analytics (54 percent).

As part of the survey, Stoltenberg also asked survey respondents which problems HIT executives would most likely attempt to solve with the help of a specialized IT consulting firm. The responses included ICD-10 (25 percent), Meaningful Use (25 percent), clinical and business intelligence (23 percent), cloud computing (21 percent) and CPOE/clinical systems implementation (20 percent).

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May 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Clinical Decision Support  Cloud EHR  Health Information Exchange  HIE  Hospital Business Intelligence  Hospital EHR  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Vendor  Hospital Healthcare IT  Hospital IT Systems  Meaningful Use  Mobile Technology
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Is Epic Stifling Health IT Innovation?

In many ways and definitely based on the buzz, Epic is at the top of the hospital EMR market. According to one estimate, about 40 percent of the U.S. population has its medical information stored in an Epic EMR, a stunning number given the level of competition in the hospital EMR space.

The question is, what impact is that having on the EMR marketplace?  According to one piece posted this week by Medical Economics,  Epic may be stifling health IT innovation due to its nearly-unassailable market lead.

As readers probably know, Epic has established an empire built around antiquated technology (MUMPS), which essentially forces any company that hopes to interoperate to bear its MUMPS core in mind. We’re talking the blunted edge here.

Perhaps more importantly, now that Epic has such a dominant market share, if it chooses to keep a closed system in place, customers will only get what innovations are driven internally by Epic.  If hospitals want innovations emerging outside the Epic bubble, they’ll have to consider the staggering costs — in some cases in the hundreds of millions of dollars — of switching outright to another vendor. If that doesn’t stifle innovation I don’t know what does.

This situation hasn’t been lost on healthcare industry leaders, some of whom have begun to balk at Epic’s rise, Medical Economics reports.

As the piece notes, Epic has attracted outspoken critics that question whether Epic’s’ market dominance is bad for the health IT world as a whole. One of those critics is Paul Levy, former CEO of Beth Israel Deaconess Medical Center, who has taken shots at the EMR giant from his “Not Running A Hospital” blog.

Levy, who Medical Economics cites as one of Epic’s toughest opponents, has been known to compare customers’ relationship with Epic to Stockholm Syndrome, a condition occurring when hostages begin to sympathize and identify with their captors.

All that being said, at the  moment, there’s little critics can do to change Epic’s business practices or development plans. Perhaps the Federal Trade Commission will step in at some point if it appears to staff there that Epic’s market control is anti-competitive.   In the mean time, though, Epic seems to have a lock on the hospital marketplace — and a disproportionate role in shaping the future of EMRs generally.

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April 30, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Hospital EHR  Hospital EHR Company  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital EMR Vendor  Hospital Healthcare IT  Hospital IT Systems
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EMRs Have Certifications Yanked

A California EMR developer has become the first to have its certification for Meaningful Use taken away by the ONC.

EHRMagic-Ambulatory and EHRMagic-Inpatient, both of which were developed by Santa Fe Springs, Calif.-based EMRMagic, failed to meet certification requirements, reports EMR Thoughts.

The de-certification process began when ONC and ONC-authorized certification body InfoGard Laboratories were notified that the EHRMagic products didn’t meet Meaningful Use certification requirements.

InfoGard Laboratories analyzed the information sent along with the notification and contacted the vendor. It then began the process of ONC-ACB required surveillance activities, according to HIN. At that point, InfoGard decided to test the two products for compliance with certain requirements.  EHRMagic’s products were then retested, and failed to meet criteria for Meaningful Use certification.

Fortunately for the company’s customers, no providers had yet attempted Meaningful Use attestation using these products. One can only imagine the frustration they would have faced if they attempted to attest in good faith and found out that the EMR product they were using wasn’t capable of supporting MU certification.

I’m left wondering whether providers would have grounds for a lawsuit against the offending vendor if they attempted certification with a product that didn’t support Meaningful Use, particularly if the vendor had any idea that this might be the case.

Realistically, it seems likely at some point in the future, some provider will be left high and dry by a certified product that shouldn’t have gotten the go-ahead.  My guess is that things will get nasty pretty quickly!

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April 29, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Hospital EHR  Hospital EHR Company  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital Healthcare IT  Hospital IT Systems  Meaningful Use
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Growing Number Of Children’s Hospitals Use EMRs

The number of children’s hospitals with EMRs in place — and compliant with Meaningful Use — has increased substantially over the last few years, though minor teaching and nonteaching institutions are not as far along, according to a new study appearing in the journal Pediatrics.

The study, which compares data on EMR adoption from 2008 with data on 2011, collected data from 126 children’s hospitals.  Researchers calculated EMR adoption rates by using existing definitions of the key functionalities which make up an EMR.  The study also looked at Meaningful Use compliance, which it evaluated by by checking whether a given hospital could meet 12 core Meaningful Use criteria.

The study found that between 2008 and 2011, the number of childrens’ hospitals with an EMR grew from 21 percent to 59 percent.  But even using 2011 data, only 29 percent of children’s hospitals had demonstrated that they could meet the 12 core criteria used as a Meaningful Use proxy.

All told, EMR adoption rates and Meaningful Use compliance rates were much higher for childrens’ hospitals than for adult hospitals as a whole.  However, the results were similar for adult and childrens’ teaching hospitals.

These results square well with an early 2012 report by HIMSS Analytics which looked at Meaningful Use Stage 1 compliance among hospitals. HIMSS found that teaching hospitals were one of the hospital types most likely to have embraced Meaningful Use.

The question, for me, is when childrens’ hospitals are going to step up further in their Meaningful Use efforts. I don’t know about you, but to me 29 percent compliance isn’t terribly impressive.

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April 24, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Filed Under: Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Meaningful Use
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