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.
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?
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?)
Today it’s back to our countdown of the top five HIS vendors, with data courtesy of HealthDataManagement magazine. Today we’re focusing on Cerner, which according to the magazine’s calculations ranks second for HIS sales, edged out only by McKesson.
Cerner claims to be the top EMR vendor in the U.S., despite competitor McKesson’s much larger size, since McKesson is in so many other lines of business. As with McKesson, we’re going to share a very quick overview of Cerner’s position in the overall HIS market, which as noted previously embraces not only clinical tools like EMRs, but also HIM, revenue cycle and access tools.
Cerner holds a very tasty 18 percent of the HIS market, by HDM consultants’ calculations. More interesting, to this audience at least, is that it’s gotten there with a big helping hand from its suite of EMR products. Here’s more to chew on, below.
Cerner Corp. (CERN) 2800 Rockcreek Parkway
North Kansas City, MO 64117
Products: For the purposes of this discussion, let’s just be cute and say “everything HIT.” That includes its popular Millennium suite of EMR products which are really seeing a big uptake in community hospitals, especially its remote hosted solutions.
2011 HIS Revenue: $2.2 billion
2010 Revenue: $1.85 billion
Summary: From 2010 to 2011, Cerner’s HIS revenue grew by 20 percent as Millenium sales yielded annual revenues of $2.2 billion. Cerner’s overall profit margin for last year was, wait for it, just about 14 percent — and over the last 52 weeks its stock is up 34.3 percent. Yeah, yeah, I’ve been an editor for 20 years but now I know I’m in the wrong business.
Interesting facts: Cerner has a strong international presence, from Belgium to Bangladesh, the Middle East and South America. Also, it now is offering “Community Works” to Critical Access Hospitals under 25 beds (a move your editor wouldn’t have expected given the predictably high cost of solutions from a company that size).
* Hospitals already at Stage 5, 6 and 7 on the HIMSS Analytics EMR Adoption Model (EMRAM)
According to HIMSS researchers, hospitals in the seven categories above are moving faster than their peers when it comes to IT adoption. Hospitals at the high end of EMRAM are moving up more quickly, as well. As hospitals geared up to meet Stage 1, researchers say, the number of hospitals at stages 6 and 7 of EMRAM is growing as well.
As we’ve previously noted here, however, calling this a success would be looking at the nearly empty glass as half-full. Even HIMSS admits that only five percent of hospitals have achieved Stage 6 of the EMRAM model (give or take) and just 1.2 percent are at EMRAM Stage 7.
There is at least a little bit of good news. Of the 585 hospitals surveyed by HIMSS, about half are ready, most likely to be ready or somewhat likely to be ready to collect incentive payments this year.
The hospitals that reported being “somewhat likely” had achieved at least two menu items, and between five and nine of the core items needed to qualify for incentives.
But hospitals with less than 100 beds — generally rural, critical access hospitals — are not doing even as well as their peers. Only 20 percent told HIMSS that they were ready or most likely to meet Stage One goals.
By the way, the HIMSS research included one discomfiting side note, on security. Of the 585 hospitals that weighed in, just 25 percent said that they protected EHR data by conducting and reviewing a security risk analysis, doing needed suricty updfates and correcting security deficiencies. Oops — there goes compliance witih 45 CFT 164.308 (a) (1), the relevant HIPAA security rule. But that’s a tale for a different blog item, isn’t it, folks?