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Health IT Haiku

Now for something completely different, folks. Here’s some haiku verses (5-7-5 syllable scheme) on EMR and HIT issues. I’m hoping y’all jump in and give it a try next.

EMR cutover
Could it be that all our work
Comes down to this day?

Everyone freaks out
EMR has gone off line
Painful nine seconds

Meaningful Use is
Years of pain and suffering
For a bite-sized check

Can’t write haiku on
interoperabili-
ty, or can you now?

Elegant, simple
EMR interface is
Rarer than diamonds

Fifty million spent
Putting in their EMR
Which they then threw out

May 20, 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.

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?

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.

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?

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.

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.

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.

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.

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.

Survey: Healthcare CIOs Average $200K In Annual Base Salary

While numbers varied widely depending on organizational factors, healthcare CIOs earned an average base salary of $208,417 in 2012, according to a recent survey conducted by CHIME.

The survey, which drew responses from small, medium-sized, large and rural facilities, drew responses from 263 CIOs from late December 2012 and early January 2013.

Some key findings from the survey included the following:

Multi-hospital, academic medical center execs make more  The average base salary reported for multi-hospital system execs was $254,054. and the academic medical center CIOs reported an average $243,229 base salary.

Smaller-hospital CIOs make much less  Top IT execs at the smallest hospitals, CAHs with 25 beds or less, got an average base salary of $125,573. Execs at hospitals with fewer than 200 beds reported an average base salary of $150,956, or about 28 percent than the overall average, notes iHealthBeat.

Standalone execs make less  CIOs with stand-alone community hospitals also responded lower income than the average, at $178,786, roughly 14 percent less than the overall average.

*  Titles matter, a lot  Hospital leaders with the title of CIO had average base salaries of $199,890, about four percent less than the overall survey average, but when they had additional titles salaries went up starkly. CIOs who were also titled vice president had an average salary of $206,788, while those with CIO and executive vice president had an average salary of $310,326, or almost 49 percent over average.  Meanwhile directors of IS or IT averaged $128,193, or about 38 percent less than the survey average.

Reporting relationships count As iHealthBeat reports, salaries varied depending on who the CIO reports to in the organization.  The 44 percent of respondents who report to the CEO earned ann average of $217,170, or about 4 percent more than average.  Meanwhile, those reporting to the CFO earned an average base salary of $175,263, or 16 percent less than the average of salaries reported.

Few and small raises reported  Despite the huge amount on health IT execs’ plates, most survey respondents reported minimal  pay raises, with almost 75 percent saying that their base salaries increased by less than 5 percent between 2011 and 2012.

So, readers, how do these numbers look to you?  Do they reflect the realities of your institutions? And how about those low raises — think hospitals are risking losing critical talent by holding that line?

April 9, 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.

Who Really Pays For EMRs?

Hospitals are adopting EMRs at a rapid clip, going through money like water in an effort to capture Meaningful Use incentives.  The idea, from a federal policy perspective, is that the EMRs will save enough money to pay for themselves while improving care on many levels.  This all sounds great, and many people are counting on this outcome.

The thing is, to date there’s been little evidence that such a welcome transformation is taking place, even within hospitals that have achieved high levels on  the HIMSS EMR adoption scale.  Just look at how things are playing out:

* Doctors and nurses may find some EMR implementations actually help them with their work, but you’re not hearing about new bursts of productivity.

* To date, the evidence has been mixed at best that EMRs generate savings through improved care efficiencies.

* While nobody expected EMRs to immediately take back the $750 billion the Institute of Medicine estimates is wasted per year in the healthcare system, one might hope to see signs that EMRs can someday move the needle — and  largely, we’re not.

So, who will ultimately pay for hospitals’ huge investments in EMRs?  It seems that it won’t be improvements in efficiency, productivity, waste or even morale, so the money has to come from somewhere.

From an economics perspective, the most obvious conclusion is that the consumer will be paying the tab. After all, service  providers simply raise prices when their expenses increase, right? In this case, not really. Given the fact that so much of hospital care is financed by insurance companies, the analysis becomes more complicated.

Insurance companies will definitely pass on costs to consumers, or restrict access, if a particular service becomes too expensive. But EMRs are a hospital operating cost, one which can’t be targeted neatly by insurers by raising a deductible or requiring a pre-approval process of some kind.

What about insurance companies absorbing the cost of EMRs?  My best guess is that hospitals will not be able to get much — if any — extra reimbursement just because they’ve invested in EMR systems.

So where in this shell game does the cost end up?  On the hospitals themselves. And that’s not a pretty picture, especially for community hospitals without economies of scale enjoyed by their bigger brethren.  My guess is that even with incentives being paid, we’re not far away from EMR-related hospital bankruptcies or layoffs entering the picture.

April 5, 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.

Real-Time Responses To EMR Training

Teaching hospital staffers and clinicians to use your EMR is a hard enough job. Figurng out just what they didn’t learn during training is even harder. But here’s a trick some hospital administrators and IT leaders are using to do just that.

A report in the HealthTechZone blog notes that at St. Joseph Hospital in Chicago, they’ve already seen some success with a technology that allows audiences to respond to quizzes embedded in EMR training materials.

The hospital’s training sessions use a polling software application called TurningPoint which allows audience members to respond to questions in real time, using either their smart phones or “ResponseCard” keypads. The technology also allows presenters to bring in audience members not in the room at presentation time and collect their responses to polls remotely.

At St. Joseph, administrators use this technology to structure their EMR training sessions more effectively and focus in on areas where the audience seems not to have understood what was presented.  It’s as simple as sending the training group on a break, reviewing the quiz and reorganizing PowerPoint slides to re-emphasize any points that the audience missed.

But the response technology’s use doesn’t end there, the blog reports. Once the formal training is over, administrators hand audience polling results to the IT team. IT administrators then use the data to address employee concerns as they proceed with the EMR rollout.

I think this is a great approach, not only for training but for gauging employee (and clinician) support for the EMR rollout, gathering input on the effectiveness of the EMR in users’ daily work lives, and generally fostering EMR acceptance by having a finger on the pulse of user sentiment.  Readers, have you tried anything like this?

February 28, 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.

Accenture: Five Questions Hospital Boards Should Ask Before EMR Buys

As we’ve noted in the past, hospitals are on not only an EMR buying binge, they’re doing a lot of switching from one EMR to another. Check out these stats from Accenture:

Accenture research shows that 4 to 4.5 percent of hospitals plan to make an EMR buying decision each year. This
could exceed 110+ EMR contracts or 200 to 250 hospitals per year. This trend is expected to continue well into the
future. In fact, in 2012, 50 percent of EMR deals [were] replacements, up from 30 percent in 2011, according to KLAS Research.

Whether your hospital is a switcher, a late adopter or  planning some kind of EMR upgrade, it’s making a decision of grave importance. So what are some of the key considerations boards should bear in mind? Here’s Accenture’s list of five key questions boards should keep front and center as they consider (more)  big EMR investments and plan for the future:

*  Does your current system offer enough functionality to meet up and coming Meaningful Use requirements, such as the ability to make patient family health histories and imaging results available? Does your current or contemplated EMR vendor have plans in place to keep up with future requirements/changes?

*  Is the EMR vendor’s development strategy in line with your strategy? “Boards should ask of the EMR vendor: do they have adequate resources…to help complete the business roadmap on time and successfully?” Accenture asks. And just as importantly: “Can the vendor help ensure that future product functions are strategically aligned to the healthcare [system's] key initatives?”

* Is your hospital currently on track to meet ICD-10 adoption and Meaningful Use Stage 2 requirements?  Is your vendor going to be able to help support you in these efforts as your hospital works to meet these multiple goals, or does it lack the resources to do so?

* If we decide to switch EMRs, do we have the internal resources needed to support such a bandwidth-sucking effort? Given competition for healthcare IT labor today, will you have the ability to hire on additional resources if needed? And while you’re at it, is your C-level and IT leadership solid enough to make such a treacherous journey?

* Can your hospital afford to switch EMRs, bearing in mind not only direct costs such as licensing, implementation and new technical support, but also ongoing support costs in the neighborhood of 20 percent per year?

To answer these questions, Accenture recommends you conduct an independent analysis of EMR vendors (presumably, rather than relying on analyst firms or peer feedback exclusively).  This sounds like a very good idea to me.

January 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.

What Hospitals Can Learn From Airports

Few of us would want to get our healthcare in the cavernous, emotionally sterile barns that are today’s airport terminals. (We definitely wouldn’t want to face a security checkpoint before we could get our care.) But there’s a fair amount of technology, data use and workflow that hospitals could intelligently borrow from airlines, as well.

Here, in no particular order of priority, are some approaches hospitals could borrow — or use more effectively — from an airline terminal:

*  Kiosks:  Sure, hospitals use kiosks, but far too few hospitals bother.  And when they do use kiosks, it’s largely about billing and perhaps appointment setting/confirmation.  Why not create a “patient card” with the ability to display a patient’s care status on a kiosk  (“Jane Smith is in imaging as of 5:32  p.m.”) and seed all of the main thoroughfares of the hospital? This would be of enormous help in orienting caregivers and for that matter, staff.

* Big-screen displays:  Yes, obviously, patient information can’t be displayed as casually as flight departure/arrival updates. But if a patient gets a code (tied to the card I mentioned above) patients and caregivers could know where to go and when. In the ED, smaller displays could show room-bound patients what activities are planned for them in what order. (Note: Check out John’s post on other uses of Digital Signage in Healthcare for similar ideas)

Wandering helpers:  When airlines are particularly busy, they sometimes send out members of their staff to wade into lines and help passengers get where they are going.  Equipped with a modified tablet accessing the same information as the kiosk, these hospital helpers could be stationed in high-traffic areas and available to help patients and family get where they need to be to participate in care. For patient-specific information, people could present their “patient card” and learn about the status and location of the specific patient.

Along with technology-based approaches like these, I’d also like to see hospitals offer a terminal-like retail strip for visitors, many of whom spend huge blocks of time on the campus and don’t have a chance to eat properly or get small errands done. But that’s for another story, perhaps. In the meantime, I think we need to look closely at how airlines marry people flow and technology — it could be a good thing for the industry.

January 23, 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.