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!

Telemedicine A Growing Priority For Hospitals

Posted on April 29, 2016 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.

Telemedicine programs are not new to hospitals. In fact, tele-stroke and tele-ICU programs have gained significant ground over the past several years, and other subspecialties, such as tele-psychiatry, seem likely to grow in popularity.

In coming years, telemedicine will go from being a one-off strategy to an integral part of hospital care delivery, if a new survey is any indication. Government and private insurers are gradually agreeing to pay for telemedicine services, knocking down the biggest obstacle to rolling out such programs. And while integrating telemedicine services with EMRs poses major challenges, hospital leaders seem determined to address them.

Virtually all of the hospitals responding to the survey, which was conducted by telemedicine vendor ReachHealth, told researchers that they were busy planning and preparing for telemedicine programs. Twenty-two percent of survey respondents, which also included some medical practices, said that rolling out telemedicine programs was one of their top priorities, and another 44% said that it was a high priority. Health systems averaged 5.51 telemedicine service lines, up almost 20% from last year.

I was interested to note that 96% of respondents were planning to roll out telemedicine because they felt it would improve patient outcomes. I’m not aware that there’s any substantial body of evidence demonstrating that telemedicine can have this effect, but clearly this is a widespread belief.

Also, it was a bit surprising to read that “improving financial returns” was a very low priority for providers when developing telemedicine programs. On the other hand, as researchers point out, hospitals and practices to see improved patient satisfaction as a driver of ROI. Apparently, execs responding to this survey are convinced that telemedicine to have a substantial effect on satisfaction and outcomes, though to date, only 55% said telemedicine was improving outcomes and 44% felt it was boosting patient satisfaction.

Researchers also found that providers that dedicate more resources to telemedicine are seeing more success than those that don’t. Specifically, hospitals and clinics that have a 100% dedicated telemedicine program manager in place were doing better with their initiatives.

In fact, two thirds of respondents with a dedicated program manager in place ranked their efforts to be “highly successful,” while only 46% of programs without a dedicated program manager met that description. (The programs were most successful when a VP or director was put in charge of telemedicine efforts, but only slightly more than when a CEO or coordinator was in charge.)

That being said, it seems that the highest barriers to telemedicine success are technical. The respondents complained that the lack of common EMR in hub and spoke hospitals, and the lack of integration between telemedicine and their current EMR, were still standing in their way. Many were also concerned about the lack of native telemedicine capabilities in their EMR.

Despite all of the obstacles to creating a flourishing telemedicine program, hospitals and clinics have continued to make progress. In fact, 36% have had a tele-stroke program in place for more than three years, 23% tele-radiology for three years plus, and 22 percent have had neurology and psychiatry telemedicine programs for three years or more. ReachHealth researchers note that service lines requiring access to specialists are growing more rapidly than other service lines, but contend that this is likely to shift given pending shortages of primary care physicians.

Admittedly, any survey published by telemedicine vendor is likely to be biased. Still, I thought these statistics were worth discussing. Do they track with what you’re seeing out there? And do you think EMR vendors will do more to support telemedicine anytime soon?

It’s Time For A New HIE Model

Posted on April 25, 2016 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.

Over the decade or so I’ve been writing about HIEs, critics have predicted their death countless times – and with good reason. Though their supporters have never backed down, it’s increasingly clear that the model has many flaws, some of them quite possibly fatal.

One is the lack of a sustainable business model. Countless publicly-funded HIEs, jumpstarted by state or federal grants, have stumbled badly and closed their doors when the funding dried up. As it turns out, it’s quite difficult to get hospitals to pay for such services. Whether this is due to fears of sharing data with the competition or a simple reluctance to pay for something new, hospitals haven’t moved much on this issue.

Another reason HIEs aren’t likely to stay alive is that none can offer true interoperability, which diminishes the benefits they offer. Admittedly, some groups won’t concede this issue. For example, I was intrigued to see that DirectTrust, a collaborative embracing 145 health IT and provider organizations, is working to provide interoperability via Direct message protocols. But Direct messaging and true bilateral health information exchange are two different things. (I know, I’m a spoilsport.)

Yet another reason why HIEs have continued to struggle is due to variations in state privacy rules, which add another layer of complexity to managing HIEs. Simply complying with HIPAA can be challenging; adding state requirements to the mix can be a big headache. State laws vary as to when providers can disclose PHI, to whom it can be disclosed and for what purpose, and building an HIE that meets these requirements is a big deal.

Still, given that MACRA demands the industry achieve “widespread interoperability” by 2018, we have to have something in place that might work. One model, proposed by Dr. Donald Voltz, is to turn to a middleware solution. This approach, Voltz notes, has worked in industries like banking and retail, which have solved their data interoperability problems (at least to a greater degree than healthcare).

Voltz isn’t proposing that healthcare organizations rely on building middleware that connects directly to their proprietary EMR, but rather, that they build an independent solution. The idea isn’t incredibly popular yet — just 16% of hospital systems reported that they were considering middleware, according to Black Book – but the idea is gaining popularity, Voltz suggests. And given that hospitals face continued challenges in integrating new inputs, like mobile app and medical device data, next-generation middleware may be a good solution.

Other possible HIE alternatives include health record banks and clearinghouses. These have the advantage of being centralized, connected to yet independent of providers and relatively flexible. There are some substantial obstacles to substituting either for an HIE, such as getting consumers to consistently upload their records to the record banks. Still, it’s likely that neither would be as costly nor as resource-intensive as building EMR-specific interoperability.

That being said, none of these approaches are a pushbutton solution to data exchange problems. To foster health data sharing will take significant time and effort, and the transition to implementing any of these models won’t be easy. But if the existing HIE model is collapsing (and I contend this is the case) hospitals will need to do something. If you think the models I’ve listed don’t work, what do you suggest?

CPOE Alerts Still Vex Doctors

Posted on April 20, 2016 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 Castlight Health has found that while nearly all hospitals have implemented CPOE systems, those systems are far from perfect. And that may be because too many clinicians find system alerts to be a distracting annoyance.

The research, based on an analysis of data collected by The Leapfrog Group, found that 96% of hospitals reported use of a CPOE system, up from 33% in 2010 in a scant 2% in 2001.  This data is drawn from the 2015 Leapfrog Hospital Survey of 1,750 U.S. hospitals.

But while the high adoption rate might be good news, it comes with bad news as well. The Castlight analysis found that even where hospitals had CPOE systems in place, 39% of possibly harmful drug orders and 13% of potentially fatal orders weren’t flagged by the system in place.

The most common errors that didn’t get flagged included when clinicians prescribed the wrong meds for the patient’s condition, or the wrong dose or meds entirely inappropriate for kidney function, and the failure to display a reminder to test drug levels after issuing medication.

These errors are occurring despite the fact that many of the hospitals studied by Leapfrog (64%) met its CPOE standard. To do so, the hospitals had to alert physicians about a minimum of 50% of common, serious prescribing errors. Also, physicians had to order at least 75% of inpatient medication orders through a CPOE system.

So if the CPOE system is being used actively, and performing as it should in most cases, why would nearly 40 percent of potentially harmful drug errors slip by? The answer may be that fairly or not, CPOE alerting is still seen as a hindrance rather than a help by many physicians.

While I don’t have hard statistical evidence to this effect, the anecdotes doctors share suggest that some click through alerts as quickly as possible. One physician blogger shared that he was quite frustrated by the alert generated when he wanted to prescribe 81mg baby aspirin tablets, which patients can buy over the counter. I understand his frustration (and even what seems like wounded pride).  And if it took several clicks to dismiss the related prompts, I’m sure it was indeed annoying.

On the other hand, as my colleague John Lynn rightfully notes, doctors aren’t going to blog or tweet about the time the CPOE system alert saved them from making a major prescribing error. So there is a bias to comments and blog postings since they only cover the negative side of CPOE and not the positive side. Perhaps the doctors who are working with these alerts successfully are simply going about their business and feel no need to vent. (Please note: I’m not suggesting that those who do vent are out of line in some way.)

Still, it seems quite clear that there’s considerable work to do in improving the workflow around physician alerting. If hospitals with CPOE in place are still seeing this level of potentially harmful or fatal prescribing, after many years to adapt to alerts, they need to do more to accommodate physicians.

P.S. They might want to start with a look at how Montefiore Medical Center succeeded with its CPOE rollout.

Tablets Star In My Fantasy ED Visit

Posted on April 1, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As some readers may know, in addition to being your HIT hostess, I cope with some unruly chronic conditions which have landed me in the ED several times of late.

During the hours I recently spent being examined and treated at these hospitals, I found myself fantasizing about how the process of my care would change for the better if the right technologies were involved. Specifically, these technologies would give me a voice, better information and a higher comfort level.

So here, below, is my step-by-step vision of how I would like to have participated in my care, using a tablet as a fulcrum. These steps assume the patient is ambulatory and fundamentally functional; I realize that things would need to be much different if the person comes in by ambulance or isn’t capable of participating in their care.

My Dream (Tablet-Enabled) ED Care Process

  1. I walk through the front door of the hospital and approach the registration desk. Near the desk, there’s a smaller tablet station where I enter my basic identity data, and verify that identity with a fingerprint scan. The fingerprint scan verification also connects me to my health insurance data, assuming it’s on file. (If not I can scan my insurance card and ID, and create a system-wide identity status by logging a corresponding fingerprint record.)
  2. The same terminal poses a series of screening questions about my reasons for walking into the ED, and the responses are routed to the hospital EMR. It also asks me to verify and update my current medications. The data is made available not only to the triage nurse but also to whatever physician and nurse attend me in my ED bed.
  3. When I approach the main registration desk, all the clerks have to do is put the hospital bracelet on my wrist to do a human verification that the bracelet a) contains the right patient identity and b) includes the correct date of birth for the person to which it is attached. If the clerks have any additional questions to pose — such as queries related to the patient’s need for disability accommodations  — these are addressed by another integrated app the clerk has on their desk.
  4. At that point, rather than walking back to an uncomfortable waiting room, I’m “on deck” in a comfortable triage area where every patient sits in a custom chair that automatically takes vital signs, be it by sensor, cuff or other means. In some cases, the patient’s specific malady can be addressed, by technologies such as AliveCor’s mobile cardiac monitoring tool.
  5. When the triage nurses interview me, they already have my vitals and answers to a bunch of routine clinical questions via my original tablet interaction, allowing them to focus on other issues specific to my case. In some instances this may allow the staff to move me straight to the bed and ask questions there, saving initial triage time for more complex and confusing cases.
  6. As I leave the triage area I am handed a patient tablet which I will have throughout my visit. As part of assigning me to this tablet my fingerprint will again be scanned, assuring that the information I get is intended for me.
  7. When I am settled in a patient bed in the ED, I’m given the option of either holding the tablet or placing on a swing-over bed desk which can include a Bluetooth keyboard and mouse for those that find touchscreen typing to be awkward.
  8. Not long after I am placed in the bed, the hospital system pushes a browser to the tablet screen. In the browser window are the names of the doctor assigned by case, the nurse and tech who will assist, and whenever possible, photos of the staff involved. In the case of the doctor or NP, the presentation will include a link to their professional bio. This display will also offer a summary of what the staff considers to be my problem. (The system will allow me to add to this summary if I feel the triage team has missed something important.)
  9. As the doctor, nurse and tech enter the room, an RFID chip in their badges will alert the hospital system that they have done so. Then, a related alert will be pushed to the patient tablet – and maybe to the family members’ tablet which might be part of this process — giving everyone a heads up as to how they’re going to interact with me. For example, if a tech has entered to draw blood, the system will not only identify the staff member but also the fact that they plan a blood draw, as well as what tests are being performed.
  10. If I have had in interaction with any of the staff members before, the system will note the condition the patient was diagnosed with previously when working with the clinician or tech. (For example, beside Doctor Smith’s profile I’d see that she had previously treated me for stroke-like symptoms one time, and a cardiac arrhythmia before that.)
  11. As the doctor or NP orders laboratory tests or imaging, those orders would appear on a patient progress area on the main patient ED encounter page. Patients could then click on the order for say, an MRI, and find out what the term means and how the test will work. (If a hospital wanted to be really clever, they could customize further. For example, given that many patients are frightened of MRIs, the encounter page would offer the patient a chance to click a button allowing them to request a modest dose of anti-anxiety medication.)
  12. As results from the tests roll in, the news is pushed to the patient encounter home page, scrolling links to results down like a Twitter feed. As with Twitter, all readers — including patients, clinicians and staff — should have the ability to comment on the material.
  13. When the staff is ready to discharge the patient — or the doctor has made a firm decision to admit — this news, too, will be pushed to the patient encounter homepage. This announcement will come with a button patients can click to produce a text box, in which I can type out or dictate any concerns I have about this decision.
  14. When I am discharged from the hospital, the patient encounter homepage will offer me the choice of emailing myself the discharge summary or being texted a link to the summary. (Meanwhile, if I’m being admitted, the tablet stays with me, but that’s a whole other discussion.)

OK, I’ll admit that this rather long description caters to my prejudices and personal needs, and also, that I’ve left some ideas out (especially some thoughts related to improving my interaction with on-call specialists). So tell me – does this vision make sense to you? What would you add, and what would you subtract?

P.S.  Some high-profile hospitals have put a lot of work into integrating EMRs with tablets, at least, but not in the manner I’ve described, to my knowledge.

P.S.S. No this is not an April Fool’s joke. I’d really like for someone to implement these workflows.

NYC Epic Rollout Faces Patient Safety Questions

Posted on March 30, 2016 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.

In the summer of last year, we laid out for you the story of how a municipal hospital system’s Epic EMR installation had gone dramatically south since its inception. We told you how the New York City-based Health and Hospitals Corp. was struggling to cope with problems arising from its attempt to implement Epic at its 11 hospitals, four long-term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.

At the time of last writing, the project budget had exploded upward from $302 million to $764 million, and the public chain’s CTO, CIO, CIO interim deputy and project head of training had been given the axe. In the unlikely event that you thought things would settle down at that point, we bring you news of further strife and bloodshed.

Apparently, a senior clinical information officer with the chain’s Elmhurst and Queens Hospital Centers has now made allegations that the way the Epic install was proceeding might pose danger to patients. A New York Post article reports that in a letter to colleagues, outgoing HHC official Charles Perry, M.D. compared the EMR implementation process to the 1986 Challenger space shuttle disaster.

In his letter, Dr. Perry apparently argued that the project must be delayed. According to the Post, he quoted from a presidential panel report on the disaster: “[For] a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Another Post article cited anonymous “insider” sources claiming that the system will crash, as the implementation is being rushed, and that the situation could lead to patient harm.

For its part, HHC has minimized the issue. A spokesperson told FierceHealthIT that Perry was associate executive director of the Elmhurst hospital and liason to the Queens Epic project, rather than being CMIO as identified by the Post. (Further intrigue?) Also, the spokesperson told FHIT that “if a patient safety issue is identified, the project will stop until it is addressed.”

Of course, the only people who truly know what’s happening with the HHC Epic implementation are not willing to go public with their allegations, so I’d argue that were obligated to take Perry’s statements with at least a grain of salt. In fact, I’d suggest that most large commercial Epic installations (and other large EHR implementations for that matter) got the scrutiny this public hospital system gets, they’d probably look pretty bad too.

On the other hand, it’s fair to say that HHC seems to crammed enough scandal into the first few years of its Epic rollout for the entire 15-year project. For the sake of the millions of people HHC serves, let’s hope that either there is not much to these critiques — or that HHC slows down enough to do the project justice.

Patients Deserve Complete Access To Their Health Data

Posted on February 23, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As a vigorous healthcare advocate — for both myself and ailing family members and friends — I love the idea of OpenNotes. As some readers will know, the OpenNotes model gives patients easy access to their clinician’s visit notes within the system’s EMR.

As you can see below, the idea has gone from a three-practice demo to a hot idea:

Chart courtesy of OpenNotes,org

Still, given the widespread adoption of EMRs by hospitals, you’d think the list of participating healthcare organizations would be longer.  The group represents a very small percentage of U.S. hospitals and clinics.

I’ve read many critical analyses of the OpenNotes concept, and some have a reasonable foundation. But if you dig into the analyses, it becomes pretty clear what’s going on; critics believe that doctors and patients are insecure and immature.

After all, while there might be some exceptions to the rule — such as providing too much access to mentally ill patients during an acute episode —  in general I believe that patients should have complete access to information concerning their health status and treatment.

After all, whenever possible medical treatment should be based on consensus, especially when clinician and patient don’t know each other well. No EMR on the planet can teach the doctor about my history as quickly and accurately as I can. OK, I admit it, I didn’t go to medical school, but as a 50-year old patient activist with multiple chronic illnesses spanning 30 years, I would tend to believe that I understand me better than an ED doc that met me five minutes ago.

Not only that, I’d argue that if the information a clinician creates concerns my health, well-being and safety, it’s flat unethical to keep me from seeing it. I want to know what’s going on and I want to know now. But many institutional practices make even routine data sharing difficult. I’ve even had medical practices refuse to share clinical testing results via their portal until the clinician had “approved” it. Yeah — try saying that to my face, lady.

Bottom line, both sides should be capable of addressing documented reality and debating matters of opinion like adults. Assuming otherwise might protect clinician and patients from bruised feelings, but it doesn’t improve their care. Instead, it keeps an obstacle to collaborative medicine in place which shouldn’t be there.

Hospital EMR Buyer Loyalty May Be Shaky

Posted on February 22, 2016 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.

When it comes to investing in enterprise software, just about any deal can turn sour. If you’re acquiring a mission-critical platform, there’s an even bigger risk involved, and the consequences of failure are typically dire. So any company making such a purchase may feel trapped after the contract is signed and the die has been cast.

One might hope that when hospital and health systems buy an EMR — probably the most expensive and critical software buy they’ll make in a decade — that they feel comfortable with their vendor. Ideally, hospitals should be prepared to switch vendors if they feel the need.

In reality, however, it looks like many hospitals and health systems feel they’re trapped in their relationship with their EMR vendor. A new study by research firm Black Book has concluded that about a solid subset of hospitals feel trapped in their relationship with their EMR vendor. (Given what I hear at professional gatherings, I’m betting that’s on the low side, as their EMR has driven so many hospitals deep into debt.)

Anyway, Black Book compiles an HIT Loyalty Index which assesses the stability of vendors’ customer base and measures those customers’ loyalty. For its current batch of stats, Black Book drew on 2,077 hospital users, asking about their intentions to renew current contracts, recommend their inpatient EMR/HIT vendor to peers and the likelihood of their buying additional products like HIE and RCM tools from their existing vendors.

The results shouldn’t give any great pleasure to HIT vendors. All told, loyalty to inpatient EMR/HIT vendors fell 6%, from 81% to 75% committed clients. While it’s not horrible to have 75% truly happy with your product, this is not a metric you want to see trending downward.

When you combine these numbers with other signs of dissatisfaction, the picture looks worse. Roughly 25% of respondents said that they were only loyal to their vendor because they were forced to follow administrative directives. And as we all know, ladies and gents of the vendor world, you can’t buy love. These 25% of dissatisfied professionals will do their job, but they aren’t going to evangelize for you, nor will they be quick to recommend more of your products.

All is not bleak for EMR vendors, however. Some HIT vendors saw year-to-year growth in hospital client loyalty. Vendors with the biggest loyalty increases included Allscripts, Cerner, CPSI, NTT Data and athenahealth/RazorInsights.

By the way I noted, with a touch of amusement, that mega-costly Epic doesn’t appear on the latter list. Just sayin’.

HIMSS Puts Optimistic Spin On EMR Value Data

Posted on February 5, 2016 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.

After several years of EMR deployment, one would think that the EMR value proposition had been pretty well established. But the truth is, the financial and clinical return on EMRs still seems to be in question, at least where some aspects of their functioning are concerned.

That, at least, is what I took from the recent HIMSS “Value of Health IT Survey”  released earlier this month. After all, you don’t see Ford releasing a “Value of Cars Survey,” because the value of a car has been pretty much understood since the first ones rolled off of the assembly line more than a century ago.

Industry-wide, the evidence for the value of EMRs is still mixed. At minimum, the value proposition for EMRs is a remarkably tough case to make considering how many billions have been spent on buying, implementing and maintaining them. It’s little surprise that in a recent survey of CHIME members, 71% of respondents said that their top priority for the next 12 months was to realize more value from their EMR investment. That certainly implies that they’re not happy with their EMR’s value prop as it exists.

So, on to the HIMSS survey. To do the research, HIMSS reached out to 52 executives, drawn exclusively from either HIMSS Analytics EMRAM Stage 6 or 7, or Davies Award winning hospitals. In other words, these respondents represent the creme de la creme of EMR implementors, at least as HIMSS measures such things.

HIMSS researchers measured HIT value perceptions among this elite group by sorting responses into one of five areas: Satisfaction, Treatment/Clinical, Electronic Information/Data, Patient Engagement and Population Management and Savings.

HIMSS’ topline conclusion — its success metric, if you will — is that 88 percent of execs reported at least one positive outcome from their EMR. The biggest area of success was in the Treatment/Clinical area, with quality performance of the clinical staff being cited by 83% of respondents. Another area that scored high was savings, with 81% reporting that they’d seen some benefits, primarily in coding accuracy, days in accounts receivable and transcription costs.

On the other end of the scale, execs had to admit that few of their clinical staffers are satisfied with their EMRs. Only 29% of execs said that their EMR had increased physician satisfaction, and less than half (44%) said their nurses were more satisfied. If that isn’t a red flag I don’t know what is.

Admittedly, there are positive results here, but you have to consider the broader context for this study. We’re talking about a piece of software that cost organizations tens or even hundreds of millions of dollars, upon which many of their current and future plans rest. If I told you that my new car’s engine worked and the wheels turned, but that the brakes were dodgy, fuel economy abysmal and the suspension bumpy, wouldn’t you wonder whether I should have bought it in the first place?

Are You Prepared For Healthcare Ransomware?

Posted on February 3, 2016 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.

Earlier this month, a Texas hospital was hit with a particularly loathsome virus.  Leaders at Mount Pleasant, Tx.-based Titus Regional Medical Center found out on January 15 that a “ransomware” virus had encrypted files on several of the medical center’s database servers, blocking access to EMR data as well as the ability to enter data into the system.

In this kind of attack, the malware author demands a financial ransom to be paid for freeing up the data. TRMC didn’t disclose how much money the attacker(s) demanded, but it may have been an immense sum, because the hospital apparently thought that bringing in pricey security consultants and enduring several days of downtime was preferable to paying up. Although, they also probably realized the slippery slope of paying the ransom and also there’s no guarantee those receiving the ransom money will actually permanently fix the problem.

It would be nice to think that this was just a passing fad, but researchers suggest that it’s not. In fact, US victims of ransomware reported losses of more than $18 million in 14 months, according to an FBI report issued in June.

According to one news report, the average ransomware demand is about $300 per consumer. The amount demanded goes up, however, when business or government organizations are involved. For example, when a series of small police departments in Massachusetts, New Hampshire and Tennessee were hit with a ransomware attack tying up their key databases, they ended up paying between $500 to $750 to get back access to their data. One can only imagine what a savvy intruder familiar with the life-and-death demand for health information would charge to free up an EMR database or laboratory information system data store.

But the threat isn’t just to enterprise assets. Not only are hospital enterprise network attacks via ransomware likely to increase, these exploits could take place via wearables or medical devices in 2016, according to technology analyst firm Forrester Research. Such attacks don’t just use medical devices to reach databases; Forrester predicts that some ransomware attacks will disable the medical devices themselves.

Given how important mobile technology has become to healthcare, it’s worth noting that ransomware is increasingly targeting mobile devices as well. For example, a recent strain of Android virus known as Lockdroid ransomware is now afoot. While it has no direct healthcare implications, one of the things it does is threaten to send a user’s browsing history to friends and family unless they pay the ransom. The victim, who may get tricked into allowing malicious code to gain admin privileges on their device, could end up having their personal data — and perhaps data from an EMR app — sent wherever the attacker chooses.

It seems to me that the ransomware threat will push healthcare organizations to mirror their core data assets in new and heretofore unheard of ways. HIT departments will have to bring disaster recovery methods and network intrusion defenses to prevent the worst possible outcome — a hack that kills one or more patients — and quickly. Meanwhile, if a company specializing in protecting healthcare firms from ransomware doesn’t exist yet, I suspect one will exist by the end of 2016.

EMR Usability A Pressing Issue

Posted on January 29, 2016 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 few months ago, in a move that hasn’t gotten a lot of attention, the AMA and MedStar Health made an interesting play. The physicians’ group and the health system released a joint framework designed to rank EMR usability, as well as using the framework to rank the usability of a number of widely-implemented systems.

What makes these scores interesting is not that they’re just another set of rankings — those are pretty much everywhere — but that the researchers focused on EMR usability. As any clinician will tell you (and many have told me) despite years of evolution, EMRs are still a pain in the butt to use. And clearly, market forces are doing little to change this. Looking at where widely-used systems rate on usability is a refreshing look at a neglected issue.

To score the EMRs, researchers dug into EMR vendor testing reports from ONC. This makes sense. After all, though the agency doesn’t use this data for certification, the ONC does require EMR vendors to report on user-centered design processes they used for eight capabilities.

And while the ONC doesn’t base EMR certifications on usability, my gut feeling is that the data source is pretty reliable. I would tend to believe that given they’re talking to a certifying authority, vendors are less like to fudge these reports than any they’d prepare for potential customers.

According to the partners, Allscripts and McKesson were the highest-scoring EMR vendors, gaining 15 out of 15 points. eClinicalWorks was the lowest-scoring EMR, getting only 5 of 15 possible points. In-betweeners included Cerner and MEDITECH, which got 13 points each, and Epic, which got 9 points.

And here’s the criteria for the rankings:

  • User Centered Design Process:  EMRs were rated on whether they had a user-centered design process, how many participants took part (15+ was best) and whether test participants had a clinical background.
  • Summative Testing Methodology: These ratings focused on how detailed the use cases relied upon by the testing were and whether usability measures focused on appropriate factors (effectiveness, efficiency and satisfaction).
  • Summative Testing Results:  These measures focused on whether success rates for first-time users were 80% or more, and on how substantive descriptions of areas for improvement were.

Given the spotty results across the population of EMRs tested, it seems clear that usability hasn’t been a core concern of most vendors. (Yes, I know, some of you are saying, “Boy howdy, we knew that already!”)

Perhaps more importantly, though, it can be inferred that usability hasn’t been a priority for the health systems and practices investing in these products. After all, some of the so-so ratings, such as that for the Epic product, come from companies that have been in the market forever and have had the time to iterate a mature, usable product. If health systems were demanding that EMRs be easy to use, the scores would probably be higher.

Frankly, I can’t for the life of me understand why an organization would invest hundreds of millions of dollars (or even a billion) dollars in an EMR without being sure that clinicians can actually use it. After all, a good EMR experience can be very attractive to potential recruits as well as current clinicians. In fact, a study from early last year found that 79% of RNs see the hospital’s EMR as a one of the top 3 considerations in choosing where to work.

Maybe it’s an artifact of a prior era. In the past, perhaps the health systems investing in less-usable EMRs were just making the best of a shoddy situation. But I don’t think that excuse plays anymore. I believe more providers need to adopt frameworks like this one, and apply them rigorously.

Look, I know that EMR investment is a complex dance. And obviously, notions of usability will continue to evolve as EMRs involve — so perhaps it can’t be the top priority for every buyer. But it’s more than time for health organizations to take usability seriously.