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Critical Access, Small Hospitals Lagging In Meaningful Use

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.

It’s not lost on the ONC that these hospitals face significant disadvantages in getting their Meaningful Use program rolling. About a year ago, the agency rolled out a campaign intended to get 1,000 critical access and small rural hospitals meaningfully using certified EMR technology by the end of 2014. To get things rolling, ONC is spending up to $30 million for Regional Extension Centers targeting these facilities.

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.

August 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.

Larger CO Hospitals On Board With RHIO

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.

The ultimate question here, as it is with any HIE, is whether the business model is sustainable.  For the financial year ending September 30, 2012, CORHIO had total revenue of  about $9.7 million (between grants, contracts and implementation fees), and total expenses of $9.5 million. That’s not much of a margin, especially in the capital-intensive world of health IT.

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?

July 29, 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.

Gap Between Small/Rural and Large/Urban Hospitals Closing

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.

November 7, 2012 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.

ONC Wants 1,000 More Smaller Hospitals To Be Meaningful Users

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.

October 12, 2012 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 Patient Flow Software

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.

August 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Cerner Sued Over Failed Hospital Installation

We seldom hear about these things (probably because of the EHR Gag Clauses that John wrote about previously), but this time word has gotten out. According to a report in The Kansas City Star, a critical access hospital northwest of Pittburg, Kan. has sued Cerner Corp. over an allegedly botched EMR installation.

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.

What are your thoughts, readers?

July 17, 2012 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.

EMR Gap Grows Between Large, Small Hospitals

Meaningful Use incentives may have boosted EMR adoption dramatically, but the incentive program has had an uneven effect on the industry, new research suggests.

According to a new study published  in the journal Health Affairs, the EMR adoption gap between small- and large-hospitals is substantial and growing.  The study drew on responses by executives from 2,646 hospitals, or about 58 percent of all acute care hospitals in the country.

First, the good news. Researchers found that hospitals with EMRs grew from 15 percent in 2010 and 26.6 percent in 2011. They also found that the number of hospitals with a “comprehensive system”  rose from 3.6 percent to 8.7 percent, according to a piece in Information Week.

The not-so-good news, however, is that not all hospitals are joining the party at the same rate.  The study reported that 15 percent EMR adoption gap seen in 2010 has grown to almost 22 percent last year.

And the problem doesn’t end there. As Chantal Worzala, director of policy at the American Hospital Association and co-author, told the magazine, it’s clear that smaller hospitals’ problems may get worse over time.

As hospitals struggle to move through MU stage one and move into Stage 2 compliance, smaller hospitals are likely to get further and further behind, as they don’t have the infrastructure or staff to allow for high-volume exchange of clinical data.

So, what should happen next?  Researchers had a couple of suggestions for policy-makers:

* Consider lowering the MU Stage 2 bar for smaller, rural and nonteaching hospitals
* Create a special program designed to bring hospitals with little health IT in place on board with an EMR

Short of buying systems for half the country’s hospitals, though, I don’t think the government can do much to  eliminate this adoption gap. With hospitals short of IT staff, facing a tight budget and running on a narrow or non-existent margin, moderate incentives and pressure alone won’t do the trick.  Readers, what solutions would you suggest?

May 17, 2012 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.

Connecting EMRs and Smart Pumps Proving Difficult

As they settle into their implementation, hospitals are hoping to connect key medical devices to their EMRs. But vanishingly few have pulled off connecting one important device, the smart infusion pump, according to recent research by KLAS.

KLAS’s new study surveyed 251 providers from 218 organizations.  Researchers concluded that less than 10 providers in the country are tying smart pumps to their EMRs, despite the fact that most providers see such connections as an important safety measure.  The smart pumps let clinicians know if the pumps aren’t set to match a facility’s guidelines, while standard pumps are programmed by hand.

More than half of providers told KLAS that EMR integration is a key factor in selecting future pumps, the firm says.  And they handed out higher satisfaction ratings to vendors whose technology development is moving along. Smart pump vendors Baxter, Carefusion and Hospira, for example, led in wireless technology.

That hospitals are demanding wireless pumps that connect with EMRs is no big surprise. Far too many — 23 percent — of surveyed provider organizations reported serious medication incidents within the previous 24 months.  Sixty percent of the serious errors were made while using drug libraries.  Clearly, using the libraries is good, but connecting to an EMR with auto-programming could  make a difference.

Given the difference EMR-connected pumps could make, why are so few providers already connected?  Well, one obvious issue is that only 60 percent of providers are live on wireless pump technology, which is necessary to get the integration done.

It’s not just the pump that’s an issue, however. When hospitals roll out this approach, it requires a great deal of coordination between IT, EMR users, clinical analysts and more, notes Kristen O’Shea, clinical transformation officer for WellSpan Health, who spoke with InformationWeek magazine about her organization’s smart-pump rollout.

To make sure the team worked together smoothly with the new device connections, WellSpan created a new hybrid biomedical/IT position to manage medical device connectivity. (Smart move — maybe more would be getting done in the EMR/device connection realm if they did more hiring of this kind?)

May 10, 2012 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.