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Cerner Agrees To Pay $106M Over Allegedly Defective Software

After years of back and forth, Cerner has settled a dispute with a North Dakota hospital claiming that Cerner’s financial software was defective and didn’t deliver expected business benefits.

Back in April 2012, Trinity Health told the vendor that it was transitioning away from Cerner’s patient accounting software solution and certain IT services provided by Cerner. At the time, it alleged that the patient accounting solution didn’t work right.  Of course, Cerner disputed the allegations, according to its 10-K yearly report.

The two players began arbitration in December 2013, a move which allowed Cerner to collect some payments due from the hospital.  At the outset, Cerner was predicting liability you of up to $4 million, while Trinity anticipated damages totaling $240 million.

Ultimately, the two agreed upon a settlement under which Cerner would pay Trinity $106 million. Interestingly, Trinity is continuing as a client of Cerner for its clinical solutions, something you might not expect under the circumstances.

This is a particularly unusual outcome for a vendor/hospital dispute, because most vendor contracts contain clauses to eliminate “consequential damages,” which limit hospital’s ability to take legal action, notes Trinity attorney Michael Dagley. That being said, there are areas under state and common law provisions of consumer fraud statutes, under which manufacturers cannot misrepresent product capabilities and benefits.

Knowing how hard it is for a hospital to sue a vendor of IT services, it makes you wonder whether the growing number of hospitals dumping their current EMR are doing so because they’re not getting what they want but can’t sue to get their money back.  While it may be heinously expensive, buying a new EMR and installing it is certainly faster than going through years of court proceedings and then having to buy another EMR nonetheless.

March 12, 2014 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.

Is IT The Reason CEO Turnover Is So High?

A new study from the American College of Healthcare Executives reports that hospital CEO turnover increased to 20 percent in 2013, the highest rate reported since ACHE began tracking these numbers in 1981.

There are several reasons one could identify as causes for high CEO turnover, including the retirement of baby boomers and the trend towards consolidation in the industry, which may eliminate jobs.

All that being said, I believe that the most likely reason for high CEO turnover of late is the turmoil around IT, including but not limited to evaluating and buying equipment from EMR vendors, managing process changes as the EMR is installed, seeing to it that the EMR doesn’t bankrupt the hospital and more.

And then, there is a need for management to be responsible for all of the systems that feed into the EMR, and to do something with the data that they produce.

Bottom line, it’s hardly surprising that there are a record number of CEOs struggling to stay on top of the crest where IT is concerned.  And it’s also not too surprising that some CEOs, who had done very well as the responsible leader with their hands on the wheel, might be less suited to the massive changes that can occur in the wake of IT transformation.

No, in reality it’s not very surprising that this is a time of high turnover for CEOs.  When you pile on the various revolutions taking place in healthcare IT, and the need to lead your staff through them, manage them and prepare for the future, you have what might be seen as an impossible job for some CEOs. It’s not a big surprise that particularly high number of hospital CEOs are calling it a day — or having it called for them.

March 11, 2014 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.

Stanford Team Builds EMR Automated Checklist Solution

A Stanford team has built an automated checklist that pulls data out of EMRs and pushes patient-specific alerts to caregivers.  The checklist, along with the dashboard style interface clinicians use to work with it, has caused a threefold drop in the rates of a serious type of hospital acquired infection, according to a study of the solution published in Pediatrics.

The study, conducted by researchers in the pediatric intensive care unit at the Stanford University School of Medicine and the Lucile Packard Children’s Hospital Stanford, was focused on preventing bloodstream infections that begin in central lines.

To create the automated checklist, the research team collaborated with engineers from HP Labs, who programmed the checklist and displayed real-time alerts a large LCD screen in the nurses’ station.  Alerts from the system were generated in three different colors, red, yellow and green, each with a specific action to be taken in response to the dot. For example one dot might indicate that it was time for patients central line to be changed, and another if it was time for caregivers to reevaluate whether medications given in the line could be switched to oral meds instead.

Using the checklists created from EMR data it was much easier for clinicians to follow national guidelines in keeping central lines infection free. During the study, researchers reported, the rate of central line infections in the hospital’s PICU fell from 2.6 to 0.7 per 1000 days of central line use.

According to Natalie Pageler, MD, the study’s lead author, these are the kinds of solutions that can transform the use of EMRs  by digging into their deeper capabilities. “Electronic medical records are data rich of information poor,” Dr. Pageler said. “Often, the data in electronic medical records is cumbersome for caregivers using real-time, but this study showed a way to change that.”

March 5, 2014 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.

Large Health Systems May Miss Stage 2 Deadline

Usually, it’s the small institutions that are having fits when an IT program deadline is approaching. This time around, it’s the big boys that are struggling.

Intermountain Healthcare has announced that the organization will probably not attest to Stage 2 of the Meaningful Use program this year over concerns about patient safety, according to iHealthBeat

In an interview with HealthLeaders Media, CIO Marc Probst said that with the organization transitioning from its own EMR to EMR software from Cerner, all the software will not be running at all of the locations by the end of this year. This isn’t surprising after the relatively recent announcement that Intermountain would be switching to Cerner.

It’s not clear what it says about the success of the Meaningful Use Stage 2 program, other than that Intermountain has other priorities, but it does make you wonder what other large health systems will take a similar posture.

After all, ONC Chief Medical Officer Jacob Rieder (who also spoke with HealthLeaders) said that other large institutions are reporting similar situations. As amazing as it sounds considering the money involved, I won’t be surprised if we see more institutions following similar paths. There are a decent number of hospitals that haven’t even selected an EHR software.

According to Reider, it will be easier for small providers to meet Stage 2 requirements, given that they generally don’t have to plan as far into the future. But when it comes to large health systems, it seems that achieving this year’s Meaningful Use goal is a bridge too far.

March 4, 2014 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.

Health IT, Mobile Devices and the “Smart Patient”

This week, Dr. Geeta Nayyar, MD, MBA, is at HIMSS. Among the reasons she’s there is that she believes in the power of health IT play a key role in the creation of “smart” patients, patients  who are educated, involved, and engaged in their care.

In a blog item she wrote from the show, Dr. Nayyar suggests that health IT is central to patient engagement — and will eventually be at the center of a concept known as Personal Health IT.  I found this to be a fascinating idea, one which, as care devolves from centralized machinery to a dialogue with mobile devices, is likely to take the healthcare world by storm.

As she notes, mobility will be an essential element in any smart patient strategy, given the potential for mobile devices and apps to educate, inform and motivate patients around the clock.  But patient engagement also calls for technology in the hospital or physician’s office. For example, she notes, this could include kiosks for updating a patient’s EMR, large display screens in exam rooms were doctors and patients are both few scans, lab reports and other findings together as a team.

After a physician encounter, a patient can then meet with another staffer who could download the Providers app to a smart phone or tablet, demonstrate how an e-prescription would work or even pass along a thumb drive with evidence-based studies, clinical instructions or relevant websites as part of a take-home package for patients, she suggests.

Dr. Nayyar concedes that for many clinicians, this will prove to be a disruptive experience and a dramatic change from traditional clinical and business protocol. What’s more, there are some patients who are not ready on that level, she admits.

But the notion of a mobility enabled smart patient strategy strikes me as an excellent idea. From Dr. Nayyar’s blog, it seems clear that this is all of the experimental stage but it seems to be heading in a very intelligent direction. What do you think?

February 27, 2014 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.

United States Set to Be World’s Largest EMR Marketplace

Whatever its faults, It’s clear the Meaningful Use program did one thing right, that’s filled hospitals and doctors’ offices with EMRs. So successful was the program in doing so that the United States is soon to lead the world has an EMR marketplace.

A new study by Accenture predicts that the United States will remain the world’s largest EMR marketplace by the end of 2015, growing 7.1% per year until then.  In other words, United States’  EMR market will hit $9.3 billion by that point.

Worldwide, the EMR marketplace is expected to reach $22.3 billion by the end of 2015, with North America and South America making up $11.2 billion of that projection, the combined marketplaces of Europe, the Middle East, and Africa projected to account for $7.1 billion, and the Asia-Pacific region $4 billion.

Accenture lists several reasons why the US is leading the world in EMR market growth, but we already know what they are: pressure from regulators to interoperate, changes in reimbursement that emphasize EMR capabilities, the use of EMRs for population health management and of course, payouts for Meaningful Use success and penalties for failure.

It’s worth noting that at this point, however, it’s not just EMRs that will be necessary to meet current health system goals. As providers transition on  towards MU Stage 3, they’ll need to adopt population analytics in the mobility to help manage the transition.

The bottom line is that by the end of 2015, the EMR market should be pretty well tapped out throughout the Western world, and tools to use with EMRs, such as data analytics for population management, are the next frontier for rapid market growth.

February 25, 2014 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.

Hospitals Using Tablets to Improve EMR Access

Some high profile hospitals are turning to tablets as a way to give physicians better access to EMRs when they’re walking the halls.  Using tablets is seen as a way of working around desktops’ limitations in making better use of EMRs’ capabilities, according to MedPageToday.

For example, back in 2010, the University of Chicago School of Medicine issued tablets to all hundred 15 internal medicine residents. After a year, three quarters of residents reported tablets help them finish tasks more quickly and spend more time on direct patient care.

In another example, the Cleveland Clinic is pilot testing the use of tablets with a few sectors of its workforce, such as its rapid response teams. Using tablets, clinicians can look up patient data on the way to the patient was crashing and be better prepared when they arrive.

In yet another instance, the University Of Pittsburgh Medical Center is testing the use of Windows tablets with cardiologists. The medical center has developed special software allowing physicians to jump between different mobile apps without having to reenter patient information to do their work.

These are just examples of how hospitals can turn mobile devices into effective extensions of the EMR, said David Collins, senior director of mHIMSS, the mobile wing of HIMSS. “If you can spend $300 on a tablet and issue these to providers so that they’re more mobile, it’s really a minimal cost for the payoff,” Collins told MedPageToday. Although, John Lynn makes a pretty good counter argument for why IT admins prefer the more expensive Windows 8 tablets over iPads or Android tablets.

These are just a few early examples of how hospitals can use tablets to make access to patient data simpler. Over the next year or two expect to see far more examples of tablet use in hospitals, as it’s become increasingly clear that they can help enhance the use of clinical data, on the spot when clinicians need it.

February 18, 2014 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.

Hospitals Don’t Prepare For Full Costs of EMR Installs

A new study published in Medical News Today concludes that UK hospitals aren’t always taking into account the full costs of implementing new EMRs, and as a result, are not receiving the full benefits of these systems.

The study, which was published in the Journal of the American Medical Informatics Association, evaluated the implementation of three EMRs — iSOFT’s Lorenzo Regional Care, Cerner’s Millenium and CSE’s RIO — across 12 diverse healthcare organizations in three regions of the UK and at different stages of implementing the systems.

Researchers also conducted 41 semi structured interviews with 36 hospital staff, members of the respective implementation teams, and those spearheading the implementation at a national level.

The research team found four overarching cost categories associated with implementing EMR system: infrastructure, personnel, facilities and other (such as training materials).

As might be expected, the hospitals involved spent their EMR budget in significantly different ways. For example some hospitals spend big on testing the software, while others spent large sums training clinicians and administrative staff to use the new system.

The hospitals also made significantly different decisions when it came to hiring new staff to cover for those who were in training. One hospital spent over $1.1 million to provide covering staff, while another spent no money at all to cover from for staff and training.

When all was said and done, hospitals were most likely to cut back on training and implementation costs. Meanwhile, hospitals were also likely to under budget for factors such as the need to back fill staff to the lost productivity, and the need to test the system due to inadequate vendor testing.

February 17, 2014 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.

Five EMR Rollout Lessons Gleaned from EMR Adoption Stage 7 Hospitals

Since 2006, HIMSS Analytics has named only 160 hospitals as reaching stage 7 in its EMR adoption model, 30 of which reached paperless status into their 2013, HIMSS reports.  To help other hospitals in their journey, HIMSS has queried some of these hospitals, and come up five methods which help hospitals in their EMR adoption process. They include the following:

1. Use the Big Bang Method

Health IT leaders who have been through the EMR rollout process and reached Stage 7 told HIMSS that “Big Bang” implementation, rather than gradual phase-in, worked well for their institutions and provided better patient experiences.

2. Universal Training

Hospitals at the top of the EMR adoption food chain say that part of how they succeed was to train everyone — the entire care delivery team rather than specific types of providers. It’s also helpful to find a core group of champions within nursing, physicians and leadership to champion the process and support their peers.

3. Respect Your Organization’s Culture

When deploying software of such a cost and complexity, it’s easy to lose sight of what makes your organization unique. Make sure your change leadership process addresses the realities of local environments, and leverages unique strengths of your staff.

4. Involve Your Whole Team

These high-performing adopters stressed that it’s important to involve operational leaders from the outset and to make the EMR a corporate strategic initiative on by clinicians, not an information systems initiative.

5. Use All of Your Resources

No matter how you do it — via peer to peer best practices discussions with other hospitals, partnering with the vendor or other strategies — take advantage of the resources you have to improve, streamline and speed up the EMR installation process.

Of course, no two hospitals are exactly alike, and some of these ideas may not fit with your culture or organizational status. But given the success hospitals have had with these approaches, they’re certainly worth a look

February 14, 2014 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.

Google Says That Its Cloud Platform Will Sign a Business Associate Agreement

Hey healthcare developers: here’s some news that might interest you. Google has announced that its cloud platform will now be HIPAA compliant and will support business associate agreement going forward, according to Healthcare IT News.

This is not Google’s first move into HIPAA compliance, HIN notes. Google started striking business associate agreements back in 2013, when the HIPAA Final Omnibus Rule went into effect, which made business associates accountable for violating certain HIPAA privacy and security rules.

Now, Google is announcing support for business agreements for its customers. Customers who are subject to HIPAA regulations on the Google cloud platform can count on HIPAA compliance by Google.

This is a smart move by Google, which is poised to snap up big revenues from healthcare cloud activity. According to one research report, global market for cloud computing in healthcare hit $4 billion by the end of 2013, and it seems extremely likely that this number will grow dramatically in coming years.

Google is taking other steps into the health care scene as well. For example, it recently introduced Google Helpouts, a tool for videoconferencing which requires a business associate agreement, which includes supporting telemedicine services.

February 13, 2014 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.