Healthcare Scene was lucky to sit down with Helen Waters, VP at MEDITECH, to talk about the EHR market and MEDITECH’s place in that market. Plus, we dive into the culture and history of MEDITECH and how it’s changed. We also explore MEDITECH’s plans around innovation, integration, and value along with MEDITECH’s efforts to deploy cloud and mobile solutions. Finally, we had to talk about healthcare interoperability. We hope you’ll enjoy this wide ranging interview with Helen Waters:
After the formal interview we did above, we allow people watching live to be able to ask questions and even hop on camera to offer their insights or ask questions of Helen in what we call the “after party.” In this “after party” discussion we talk to Helen about her thoughts on the changing healthcare reimbursement landscape and what MEDITECH is doing to prepare for it. We also talk about integrating telemedicine into MEDITECH. I also ask Helen about MEDITECH’s views on EHR APIs. Check out the second half of our interview below:
We hope you’ll enjoy this look into EHR vendor, MEDITECH.
Historically, rural hospitals have lagged when it comes to health IT adoption. But according to at least one yardstick, the HIMSS EMR Adoption Model (EMRAM), rural facilities seem to have closed much of the gap.
Just a few years ago, many rural hospitals were barely at stage one of the model, which ranks facilities from Stage 0 (All three ancillaries not installed) to Stage 7 (Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP). Only two years ago, research suggested that rural and critical access hospitals were lagging far behind in meeting Meaningful Use criteria, and risked incurring penalties this year.
By the end of 2014, however, rural hospitals averaged a Stage 4 rating (CPOE, Clinical Decision Support (clinical protocols). This compares favorably with the 4.7 rank achieved by urban hospitals, and though academic/teaching hospitals were well ahead at a 5.4 ranking, that’s a much smaller difference than you might have seen even five years ago. Meaningful Use incentives, plus overall industry pressure to automate, seem to have done their job.
I’m pondering this, in part, because the CPSI acquisition of Healthland piqued my interest. CPSI picked up Healthland, a provider of rural and critical access hospital software, for $250 million. Given rural hospitals’ history of slow HIT adoption, I wasn’t sure what CPSI saw in Healthland, though the deal does bring revenue cycle management and an EMR for post-acute care facilities to the table.
Now that I’ve learned what progress the rural health IT market has seen, I’m no longer so skeptical. In fact, when you consider that the Healthland acquisition brings 3,300 post-acute customers that it didn’t have before, it seems like CPSI got a pretty nice deal.
Given the growing strength of the rural HIT market, I don’t think the Healthland buyout will be the last domino to fall here. I can easily imagine the giants — Cerner in particular — seeing their way clear to acquiring the combined CPSI/Healthland entity. Why Cerner? Well, if for no other reasons than having a ton of cash — and a more flexible attitude than Epic — I can imagine Cerner getting excited about rural access.
But even putting aside M&A dynamics, the news from rural markets is still intriguing. While having sophisticated health IT infrastructure is a plus anywhere, my guess is that it will be particularly powerful for rural and critical access hospitals. I hope that the growth of HIT capabilities brings a breath of fresh air — and the benefits of cutting-edge care management — to facilities that have traditionally gotten the short end of the stick.
Many critical access hospitals and other smaller hospitals are falling behind on Meaningful Use and may be at risk for being slapped with Medicare reimbursement penalties in 2015, according to a study reported in Health Data Management.
The study, which appeared in the journal Health Affairs, was conducted by Mathematica Policy Research and the American Hospital Association. Its bottom line conclusion was that smaller and rural hospitals were less likely than other hospitals to have met Stage 1 criteria, and that very few had all of the IT systems in place needed to reach Stage 2, HDM reports.
The researchers noted that between 2011 and 2012, the percentage of hospitals with at least 200 beds getting Meaningful Use almost doubled, but that those with less than 100 beds had a lower rate of Meaningful Use compliance. Meanwhile, the proportion of critical access hospitals that received a Meaningful Use payment in 2012 fell slightly from the previous year.
The study also concluded that teaching hospitals had a higher rate of Meaningful Use compliance than non-teaching hospitals, and that a small percentage of government-owned and non-profit hospitals received MU incentive payments compared with for-profit facilities.
According to Health Data Management, the study isolated three challenges faced by critical access and smaller hospitals:
* Low patient volume complicates long-range planning and limits ability to maintain adequate cash flow,
* The hospitals may not be able to offer competitive salaries for skilled information technology professionals, and
* Smaller hospitals may have difficulty finding a suitable I.T. vendor.
But as I see it, funding more REC activity is far from enough. The plain fact is that mounting a Meaningful Use program is time consuming and expensive, so much so that some smaller hospitals simply make it happen without help. Maybe the time has come for the feds to offer grants outright to hospitals struggling with these challenges.
Colorado’s hospitals have reached an interoperability turning point. With the addition of Exempla Healthcare’s three Colorado hospitals to CORHIO, the Colorado Regional Health Information Organization, all of the state’s hospitals with 100 beds or more are now connected to an HIE network, reports EMR Daily News.
Right now, 29 hospitals are connected to the CORHIO HIE, with 15 preparing to connect, making a total of 44 hospitals now participating in the exchange. The latest to join are Exempla Good Samaritan Hospital in Lafayette, Exempla Lutheran Medical Center in Wheat Ridge and Exempla Saint Joseph Hospital in Denver.
Along with the hospitals, a total of more than 1,800 office-based physicians, 100 long-term and post-acute facilities, 13 behavioral health centers and five national/regional labs are either connected to or in the process of connecting to CORHIO, according to EMR Daily News.
As impressive as CORHIO’s progress is, there’s still more to be done. There are a total of 61 hospitals located in CORHIO’s service area, which means that the exchange still needs to sign up just under a third of hospitals with access to the network. Some of the hospitals which haven’t connected up are in rural areas; to help bring them under CORHIO’s wings, the exchange is partnering with the Colorado Rural Health Center.
Now, there’s no need to make big profits to provide a public service, but it’s helpful to know that your money is coming from a business model that works. I’d say that this is in doubt in CORHIO’s case. I wonder: are other notable HIEs are doing better?
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, reportsEHR 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.
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, notesiHealthBeat.
* 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 relationshipscount 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?
As readers know, we’ve been tracking the progress of Meaningful Use uptake, and data has repeatedly suggested that small and rural hospitals were lagging behind. Now, courtesy of Modern Healthcare, comes an analysis suggesting that the EMR gap between small/rural and large/urban hospitals may be closing.
The magazine, which drew this conclusion after analyzing a CMS/ONC database of meaningful users of EMR systems, found that small hospital-oriented vendor CPSI has moved to the number one position among vendors “whose hospital clients have achieved Meaningful Use with systems certified as ‘complete EHRs.’ ”
According to Modern Healthcare’s analysis, CPSI’s 266 hospital clients account for 19 percent of the 1,381 hospitals that have become meaningful users with complete EMRs.
CPSI, which typically serves hospitals of 100 beds or less, can now boast more hospitals with so-called complete EMRs than larger vendors like Epic and Meditech. Epic has 251 clients which met Meaningful Use criteria for a complete EMR, and Meditech came in third with 173 hospital clients who were meaningful users of complete EMRs.
That being said, this doesn’t mean that the small and rural hospitals don’t face significant barriers when it comes to acquiring — and more significantly, developing sophisticated uses for — robust EMRs.
As the Modern Healthcare piece notes, far more large hospitals adopted an EMR in 2011 (25.4 percent) than did small hospitals (14.7 percent). There was also a big gap between the percentage of rural hospitals who adopted EMRs (19.4 percent) versus urban hospitals (19.1 percent), according to Mathematica Policy Research.
It’s also worth noting that when last we checked, smaller hospitals were generally far lower on the HIMSS EMR Adoption Model scale. Smaller hospitals and rural facilities were on average below 2 on the seven point scale, while urban and academic institutions scored much higher.
That being said, I like how Modern Healthcare used vendor data as a proxy for looking at the status of small/rural hospital EMR adoption. Good idea. Any data we have on how hospitals are faring is good data.
As I’ve written about here in the past, small rural/critical access hospitals are struggling to keep up with Meaningful Use. These hospitals — typically 50 beds or less — are isolated, underfunded, short on staff and clinicians and sometimes without affordable connectivity options.
That’s a shame, because having telemedical functions and EMR connectivity may be far more important for these hospitals than for big academic or urban behemoths. In situations where the nearest specialist may be a day’s drive away, being able to communicate and collaborate with remote specialists can be a lifesaver.
Aware of these concerns, ONC has launched a campaign intended to get 1,000 critical access and small rural hospitals meaningfully using certified EMR technology by the end of 2014.
To help small hospitals get their legs under them, ONC has committed to spending up to $30 million for Regional Extension Centers targeting these facilities. Though ONC is shooting for 1,000 new Meaningful User hospitals , it’s willing to fund services for up to 1,501 of them. That would bring the total to more than 2,700 rural/critical access hospitals on the MU roster.
The obvious question, given the obstacles the smaller facilities face, is just how realistic ONC’s expectations are. Sure, getting them hooked up with REC services is a good thing, but is it enough to get them across the finish line?
One comment on the ONC blog had this to say on the subject of the CAH/rural hospital campaign:
The best chance for success (in my humble opinion), is a joint effort between public (REC) and private sectors. There are consulting firms with specific MU experience sitting on the bench that can provide incredible value to this process. The RECs are trying to keep up with demand while servicing thousands of ambulatory providers. If there is a way to facilitate collaboration between pubic & private sectors in a way that fosters success of this initiative, that would ensure the ONC would hit their goal of 1,000 hospitals to MU by 2014.
I think the poster is on to something. While the RECs are fine, and have the best of intentions, they’ve already got their hands full. Whether it’s a public/private partnership, an assist from state government, additional grants or other mechanisms, I think it will take more than REC funding to get the job done here.
While we have done a lot of in depth coverage of Hospital EHR systems, we haven’t spent nearly enough time on many of the other IT systems that make a hospital a success. I actually think this is true across most of the health IT industry media outlets. The $36 billion of government handouts might have had an influence on this, but it’s unfortunate. While many are distracted by the EHR incentive money, a lot of other beneficial hospital IT systems are getting left behind.
One of those non-EHR software that should be considered by a hospital is an end-to-end patient flow system. When done right, a quality patient flow system can increase patient satisfaction, improve the quality of care, and make a hospital more efficient. All of these are worthy goals for hospitals of all sizes.
Let’s take a few minutes to look at some of the important features that I believe should be incorporated in a hospital patient flow system.
End-to-End – If you’re going to implement a patient flow system, then you’re going to need a system that handles the entire patient flow. Yes, that means it should handle: transport, admitting/transfer, bed management, and discharge. As most of you know, I generally lean towards implementing best of breed software in hospitals as opposed to the all in one software behemoth. You should not follow this best of breed strategy with your patient flow system. If you want something that will kill patient flow, try to integrate multiple systems. Then, sit back and watch the finger pointing. An end-to-end system will avoid these issues, and will be key to a successful patient flow software implementation.
Customizable to Hospital Workflow – This seems like an obvious feature that you’d look for in a patient flow system. Every hospital I’ve seen has unique patient flows all over the place. However, I don’t believe most hospitals spend enough time evaluating how all of these unique patient flows will work with the patient flow system they’re evaluating. Yes, this requires early involvement from clinical staff across the continuum of care, but the benefits of involving staff early will pay off in selecting the right software and later implementing the selected system.
Graphic – There are a lot of times in software development where programmers over use graphical elements to make it look pretty without adding any real value. I don’t think that’s ever the case with a hospital patient flow software. In a fast paced hospital where nurses, doctors and other staff are quickly moving around the hospital, the visual queues of a graphical patient flow software can be life saving.
Mobile, Digital Signage, and Touchscreens – One of the most important parts of a patient flow system is which devices and interfaces it supports. It is one thing to say that a software can be used on a device and another thing to say it should be used on a device. It is well worth taking the time to understand how the patient flow system works across a wide variety of devices. Make sure that the software works well across mobile, digital signage, and touchscreen interfaces. Each one can help you solve a different patient flow challenge.
While at HIMSS, HP recorded a video of Central Logic’s CEO, Darin Vercillo, demoing some of the features of the Central Logic patient flow automation system across the range of HP devices. I think it provides an interesting visual of many of the things I mention above. Check out the video embedded below:
Obviously, you need to take a deeper dive into their patient flow software to see how it will work for your environment. However, I think the video does a good job showing you the potential of what a good patient flow software could look like across a range of devices. Considering the various workflows in a hospital, the right patient flow system will have to be flexible enough to work in a wide variety of settings.
What other things have you found differentiate patient flow software systems? What benefits have you received from a patient flow system? If you haven’t yet implemented one, why haven’t you done so yet? I look forward to hearing your thoughts and experience in the comments.
This post is sponsored by HP Healthcare, however opinions on products and services expressed here are my own. Disclosure per FTC’s 16 CFR, Part 255.
In its suit, Girard Medical Center has made some ugly accusations against the HIT giant, including allegations that Cerner promised features that the system it bought didn’t have. (Oops.)
The suit also says that Cerner had demonstrated “disparaging attitudes” about the hospital. Hey, given the size projects it usually takes on, maybe Cerner didn’t feel the $2.9 million project was worth its time, and wasn’t so diplomatic about it.
What does seem to be established fact is that after a year of work, and $1.29 million in payments from Girard, Cerner backed out of the project last September.
Girard, for its part, demanded that Cerner repay the $1.9 million. Getting no satisfaction, it filed suit, accusing Cerner of a host of no-nos such as breach of contract, negligent misrepresentation and fraud. Since that point, the suit has been kicked into arbitration, moved there by a provision of the contract Cerner managed to enforce.
Obviously, we are unlikely to ever know exactly what happened here, but I have a few theories:
– As the story notes, Girard was desperate for Meaningful Use payments, but Cerner didn’t meet the initial deadline as the two sides had apparently agreed. Did Cerner understand how important meeting such a deadline would be for a small hospital which depended on the incentive to finance the EMR?
– Maybe Cerner assigned junior people to this “little” project and they didn’t have what it took to get through the task.
– Perhaps this is an EMR install failure like many others, but one ending in a lawsuit since the tiny hospital couldn’t afford to lose its investment.