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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).

Technologies Hospital Leaders Should Watch

Courtesy of non-profit research house the ECRI Institute, here’s some of technologies that they believe hospital C-suite execs should be watching this year. This list was generated by ECRI’s in-house analysts, reports HealthLeaders. Not all of these are directly related to EMR/EHR technology, but we’ve included a few that might be of interest on the broader HIT level.

* Electronic Health Records: This is so obvious it hardly bears mentioning, but yes, EHRs are number one on the list. ECRI notes that execs should beware of possible patient harm in the effort to achieve Meaningful Use, as some HIT-related errors are emerging that can lead to serious care issues.

* mHealth: Mobile applications are becoming an increasingly commonplace part of health IT infrastructure, but managing them effectively isn’t as simple as download-install-use. This is likely to be the year hospitals need to get it right.

* Alarm Integration Technology: Alarm fatigue has been and continues to be a major issue for clinicians, with some critical care docs experiencing 350 alarms per patient per day. Increasingly, alarm integration systems are being implemented which send alerts to phones or pages, leading to more controllable alerts and quieter environments.

* Imaging and Surgery: ORs are increasingly hosting full-scale angiography systems to help guide high-risk minimally invasive surgery, as well as guiding combined open and minimally invasive surgery and verifying successful surgical completion. These hybrid ORs are expensive but have arguably improved results.

* PET/MR: The PET/MR scanner is beginning to emerge as a new mainstay in oncology, improving on the results delivered for years by the hybrid PET/CR. The PET/MR offers greater detail, helping physicians detect cancers and tumors.

I would have expected to see something on the data analytics technology front to appear this year, but it was absent from the list. I might also have expected to see cloud solutions turn up, but again, not this year. What technologies would you add to this list?

Remote Patient Monitoring Going Mainstream

This week I read a piece of news which suggests to me that we’re seeing a turning point in the use of remote monitoring technology to manage patients. It looks like AT&T is taking a major public position in support of remote monitoring via the cloud, via a partnership with a hot new startup that just raised funding, according to a report in mobihealthews.

According to the mobile health news publication, cloud-based patient monitoring company Intuitive Health just got a $3.4 million investment in what appears to be the company’s first public round of investment.

Intuitive, which completed a pilot with health system Texas Health Resources and AT&T last year, offers cloud-based remote monitoring software which can interface with any device.

The pilot involved monitoring CHF patients remotely for 90 days using wireless pulse oximeters, blood pressure cuffs and weight scales, plus tablets and apps feeding the data to the patients’ EMR records. During the pilot, THR reduced hospital readmissions for chronic heart failure patients by 27 percent, mobihealthnews reports.

According to a press release from AT&T, Intuitive’s software has since become a key component in the telecom giant’s own SaaS patient monitoring product.

Remote monitoring has been a hot topic of discussion and an emerging approach for several years, but hasn’t found an established place in day-to-day care for most institutions. With AT&T and Intuitive offering a device-agnostic model, however, I believe they will give a boost to the use of remote monitoring generally.

Personally, I’ve been cheering for remote monitoring to succeed for some time; after all, given how mobile-device-oriented people are anyway, it just makes sense to leverage those capabilities to improve their health. I hope this represents a turning point for this type of technology and that we see news of more successful pilots this year.

AthenaHealth Grabs Mobile Footprint With Agreement To Acquire Epocrates

Practice management and EMR vendor athenahealth has signed a definitive agreement to buy mobile health information giant Epocrates Inc., in a move which emphasizes the importance of mobile channels to the the future of EMRs.

athenahealth has agreed to pay $11.75 per share for Epocrates, a hugely popular mobile point-of -care app which is very broadly adopted across the U .S. physician base.

The EMR vendor must have really wanted Epocrates badly; the deal, which values Epocrates at $293 million, represents a 22 percent premium over the closing price per share on Friday, January 4, 2013. What’s more, athenahealth is tapping out its entire existing credit facility to offer an all-cash deal.

As for why athenahealth is so hot for Epocrates, I’ll let them explain. They say Epocrates ofers the following:

Better Information Access for Health Organizations — By combining Epocrates’ mobile expertise with knowledge and data from athenahealth’s cloud-based network, the combined company will be uniquely positioned to introduce new mobile applications that deliver high-value information to the clinical community when, where, and how they want it.
Advanced Mobile Workflows — the combined company will seek to pioneer new mobile workflows to improve provider efficiency and support care delivery outcomes; initial efforts will focus on care coordination, provider-to-provider communication, and patient engagement tools.
Accelerated Awareness and Growth Across the Physician Market — athenahealth would expand its current provider base of 38,000 to include the more than one million health care professionals on the Epocrates network, allowing athenahealth to build upon the highly favored Epocrates brand, recognized today by approximately 90 percent of practicing U.S. physicians.

You know what, all of the above makes a whole lot of sense. It seems far smarter to buy your way directly into phyician workflows with a trusted product like Epocrates than to compete against hundreds of me-too physician EMRs out there. Expect to see more deals like this in the future.

The Cloud and Hospitals

Let’s talk about The Cloud and Hospitals for a minute. At a session I attended at CHIME a hospital CIO said, “There’s still a lot of unknown with cloud.”

At first I was a little taken back by the comment. As an IT guy, it seems like cloud has been around forever. Plus, I would bet that every single hospital has a number of cloud based IT systems in their IT environment.

What then could be the unknown issues with the cloud that this CIO was talking about?

I found this really great resource on the IBM website about the cloud and healthcare. They hit on what is probably the biggest unknown with the cloud, HIPAA. Here’s a section which describes why it’s such an unknown.

Cloud providers hold a unique position as BAs entrusted with EPHI. When HIPAA was enacted, the concept of “the cloud” didn’t exist and probably could not have been predicted. Covered entities and other BAs are increasingly choosing to store health information in the cloud.

Then he adds in these cloud challenges:

Transferring data to the cloud comes with unique issues that complicate HIPAA compliance for covered entities, traditional BAs, and now cloud providers themselves. They include issues of control, access, availability, shared multitenant environments, incident preparedness and response, and data protection

All of these should provide any hospital CIO a moment of pause. As another hospital CIO I talked with said, “we’re still doing the cloud, but we are careful about who we work with in the cloud and how we do it.”

I think this will be the reality for the forseeable future. It takes a really well done trusted relationship for a hospital to trust a cloud provider. In the small ambulatory practice space it’s very different since there’s little doubt that the cloud provider can do much better than your neighborhood tech guy. However, this is not the case in hospitals where the decision to use the cloud or your existing in house IT staff and resources is much more complex.

The reality is that every hospital is likely going to have a mixed hosting strategy with some software hosted in house and some software hosted in the cloud. This means that every hospital CIO is going to have to figure out the cloud even if there’s still some difficult to answer questions.

Healthcare Cloud Spending Slated For Major Growth

Hospitals may still be ambivalent about using the cloud for clinical data transport, but attitudes are likely to undergo a major change over the next few years, according to research firm MarketsandMarkets. The firm projects that the healthcare cloud market will expand by about 20.5 percent per year over the next five years, hitting $5.4 billion by 2017.

Right now, healthcare cloud spending has hit roughly $1.8 billion, which represents penetration of four percent, MarketsandMarkets found. That’s just a drop in the bucket, particularly given the big competitors who are aiming their guns at the healthcare cloud market today. (Other estimates put healthcare cloud penetration at 16.5 percent of the marketplace, still a small number though meaningfully larger than MarketsandMarkets’ number.)

As our sister site EMRandHIPAA.com previously noted, Verizon’s Enterprise Solutions division is offering five “healthcare-enabled” services, including colocation, managed hosting, enterprise cloud, an “enterprise cloud express edition” and enterprise cloud private edition. Verizon hopes to capture healthcare IT managers who are worried not only about HIPAA-secure clinical data transport, but also HIPAA-appropriate data protection on site, as it’s training hosting workers to be HIPAA-ready.

Another set of deep pocketed healthcare cloud vendors are AT&T and IBM, who are partnering to capture what they deem to be a $14 billion healthcare cloud market. Under the terms of an agreement announced in early October, IBM will provide data storage facilities and services, while AT&T will provide the network.

What could possibly hold back the advance of such giants? Well, a number of issues, MarketsandMarkets notes. While vendors large and small may promise to be compliant with healthcare regs, healthcare data is challenging to manage, given that it requires special security, confidentiality, availability to authorized users, traceability of access, reversibility of data and long-term preservation.

My guess is that hospitals will respond to the efforts of vendors to attract cloud business, but that the market for public cloud services in particular won’t shoot upward as MarketsandMarkets predicts, as there’s just too many things that worry CIOs. How about you, readers?

The Dawn Of “Compliance As A Service”?

A few days ago, I posted a quick report on our EMRandHIPAA.com sister site discussing Verizon’s plans to offer a HIPAA-compliant cloud service.

Verizon, which has beefed up on security services over the past few years, seems to see its role as being compliance vendor rather than just a mere business associate. The carrier notes that not only does it offer super-secure data centers, it has trained staffers on HIPAA-specific data handling issues.

But Verizon obviously isn’t the only cloud vendor out there capable of offering HIPAA-compliant services. Could this be the dawn of CaaS (compliance as a service) for healthcare? (Others industries, like banking, are already well into this approach.)

According to reader Scott Gardner, who commented on the story, this concept has legs. “I’ve been pitching [Compliance As A Service] to cloud-based persistency vendors targeting mobility for some time,” writes Gardner, whose company Inyago focuses on private practice IT services via MacPractice. “Offering this service makes perfect sense, especially in private practice healthcare. And you get interoperability (core #14) right out of the box for all users on the platform.”

The burning question here, I suppose, is whether CIOs feel safe trusting outsiders with clinical data flow. Right now the answer seems to be “no.” As my colleague John noted in a related blog post, at present even those providers who are cloud users are more prone to access it for “commodity” services such as e-mail, file storage, videoconferencing and online learning, according to a CDW survey.

With providers needing interoperability under Meaningful Use Stage 2, the landscape may change, however. Whether or not they’re terribly comfortable with Verizon and its rivals, CIOs might find it easier to delegate compliance than cope with the difficulties of build-your-own-interoperability schemes. So perhaps CaaS really does have a chance at achieving rapid uptake — unless someone invents the insta-install HIE!

Health Management Associates Makes System-Wide Deal With athenahealth

Cloud-based EMR vendor Athenahealth has struck a deal with hospital chain Health Management Associates that its vendor competitors would die for.

HMA has signed an agreement with athena under which the chain’s 1200+ employed physicians — cutting across 15 states and 300 locations — will now use the vendor’s practice management, EMR and patient communication services. HMA’s 10,000-odd independent physicians will also have access to the systems.

In the announcement, HMA and athena took pains to emphasize that the selection process was a fair and thorough one:

Health Management selected athenahealth after a twelve-month review and due diligence process that involved more than 350 clinical experts, including more than 200 physicians. The evaluation process included detailed questionnaires, onsite and virtual demonstrations, site visits, and clinical template shootouts.

Perhaps those details were included to convince observers that the deal didn’t include some kind of payola. I don’t think doctors are going to be too impressed by the IT talk. (If it were me I’d care about only one demonstration — how it worked for me on Day One.)

HMA may not be the country’s largest hospital chain, but it’s still a heavyweight, operating 66 hospitals spanning 10,330 licensed beds. Its hospitals span Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Washington, and West Virginia.

Particularly given its scale, this deal intrigues me for a few reasons. It raises what seem to me to be important questions:

* Is HMA expecting its independent physicians to dump whatever EMR they may already have in place and switch it out for athena? Or adopt its practice management module instead of what they use now? That seems, uh, a bit unrealistic?

* I don’t know what enterprise EMR system HMA uses (do you, readers?) but whatever it is, I doubt it will plug seamlessly into to the athena cloud. How do the IT types at HMA plan to connect the whole schlemiel?

* If the independent physicians don’t want to adopt the athena package, what will HMA do? Club them like baby seals? Or just accept that a large percentage of its docs aren’t connected?

Survey: Virtually All Docs Want Mobile EMRs

Here’s news that shouldn’t come as a surprise: a new study has concluded that nine out of ten doctors would like to be able to use an EMR on their mobile device. The survey was conducted by a vendor, which arguably suggests that the study reflects its agenda, but if you’re like me you’ve been hearing the same thing from doctors almost daily.

By the way, to be clear, plenty of physicians are already accessing EMRs via mobile devices. The thing is, most access the EMR through some kludgy solution like a Citrix client, which leaves much to be desired in the way of flexibility and usability. So getting a “real” client onto the key devices is a hot item.

The survey, which was conduced by Sage Software successor Vitera Healthcare, reached out to 240 Vitera customers, most of whom were office-based physicians. In the study, which was reported by Information Week, 72 percent of respondents said they used mobile devices in healthcare. However, they mostly used their tablets and smartphones to do medical research or communicate with other staff members – in fact, only six percent were using the devices to connect to EMRs or do e-prescribing.

What stood out most of all in this research was that 91 percent of physician respondents said they’d be interested in a mobile EMR solution. Features they like the best include ability to review and update patient charts and order prescriptions, along with documenting patient encounters. In other words, they want to be able to do virtually everything they can do from a desktop.

Not surprisingly, Vitera is working on its own mobile EMR solution, designed for use on iPads (though usable on iPhones). eClinicalworks is expected to launch an iPad-native EMR shortly.

It’s a lock that over the next few months, other vendors will take the same steps. The question is how usable these iPad and Android clients will be. We’ll soon find out though!

Cerner Outage Sparks Controversy

Whew! Cerner isn’t going to live this one down easily. According to reports from the field, Cerner’s hosted EMR service was down for most of Monday, July 23, taking down both hospital and medical practice clients.

HISTalk.com, the beloved scourge of the HIT world, says the event may have taken out Cerner’s hosted network both nationally and internationally. Making things even more nasty, Cerner’s support sites seem to have been down as well.

Cerner, which used the elegantly vague phrase “unscheduled downtime” to describe the event, said that a human error was responsible for the outage but didn’t elaborate. HISTalk tweeter Richard turned said they got e-mail updates from Cerner every 15 minutes, but not every customer seems to have been attended to as closely.

Unofficially, here’s what happened. A HISTalk contributor claims that the problem was due to a mistake by a Cerner network administrator, who, when trying to update DNS records via the management console, received an error and made the change manually.

While doing so, the unfortunate administrator apparently deleted a DNS zone inadvertently. Oops! At that point, the error was replicated to all servers; and because anything using the zone couldn’t work, the tools to fix the problem weren’t available either. They then had to restore from backup which took some time.

And in the end, how bad was it? Various HISTalk.com reader reports suggested that Cerner’s service was out for all or at least a large part of the day in question. (One reader showed a graphic of a uCern ticket showing 381 minutes of outage time, or more than six hours.) Some readers reported being so frustrated that they fell back on paper processes for the day.

Now, I realize some folks are going to start tossing out questions like “What does this mean for the cloud?” I’d argue that a better question is “What does this mean for Cerner?”

Really, it’d be premature to start playing the “is the cloud to blame” game just yet. After all, we don’t all get furrowed brows and wonder aloud “what does this mean for the auto industry?” when a car crashes. This crash, like automobile accidents, may have everything to do with the specifics of Cerner’s network and little to do with the soundness of the overall technology.

Technologies Hospital Leaders Should Watch

Remote Patient Monitoring Going Mainstream

AthenaHealth Grabs Mobile Footprint With Agreement To Acquire Epocrates

The Cloud and Hospitals

Healthcare Cloud Spending Slated For Major Growth

The Dawn Of “Compliance As A Service”?

Health Management Associates Makes System-Wide Deal With athenahealth

Survey: Virtually All Docs Want Mobile EMRs

Cerner Outage Sparks Controversy

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