EMR ROI | Hospital EMR and EHR

HIMSS: Hospitals Achieving Meaningful Use Milestones

Hospitals are making good progress toward achieving Meaningful Use milestones, a new study by HIMSS suggests.

HIMSS, which surveyed 298 healthcare CIOs between December and February, found that 66 percent had already qualified for Meaningful Use stage 1, while another 4 percent expected to do so before the end of 2012, Information Week reports.

Meanwhile, 75 percent of respondents said they expect to attest for stage 2 in 2014, which as readers probably know is the first year of stage two attestations.

Given the ambitions noted by the CIOs, it’s not surprising to learn that 66 percent of them said they thought their budgets would definitely or probably increase this year. Of the remainder, 15 percent said their budgets would remain level, and 8 percent expected to see a decrease.

Last year, achieving Meaningful Use was the hospital CIOs’ top business objective, named by 24 percent of respondents, but this year, it fell to 15 percent. This year, the top health IT business objective has switched over to survival, with 21 percent saying their key goal was to sustain the financial viability of their organizations. This was followed closely by improving patient care, which came in at 19 percent.

Still, Meaningful Use will obviously stay top of mind for the CIOs, who may be better prepared than last year but still have much to handle.

After all, they expect to make serious money on achieving MU goals, HIMSS concluded. The survey found that about 30 percent of hospital CIOs expected an ROI of up to $2 million on stage 1, another 23 percent a return of $2 million to $3 million, and 16 percent expected ROI of $4 million to $5 million.

What Would It Take To Get More Hospitals On VistA?

Recently, we shared the story of of a California community hospital that decided to bypass big vendors like Cerner and Epic and go for a VistA installation instead. While Oroville Hospital ended up spending $10 million on its VistA implementation, that turned out to be about half of what it would have spent on Cerner and its big-vendor cousins. Then, to boot, Oroville got a $5 million Meaningful Use payout.

Yes, without a doubt, Oroville had a different experience when it went with VistA than it would have if it hired on Epic and had armies of be-suited consultants descend onto its campus. Any open source project faces the risk that the fervor and volunteer labor that makes up the backbone of its ongoing development efforts.

But given how much flexibility hospitals get out of the deal, and how much they save, it seems to me that you’d still expect to see more VistA projects being mounted. What would it take? Here’s a few ideas:

* Get a CCHIT-certified VistA product out there: Right now, hospitals don’t have such a choice. The only reason Oroville got its instance certified was thanks to special help from World VistA.

* Have more happy talk stories on how VistA can really work appear in serious business publications like Forbes: Arguably, peer pressure is a major reason hospitals stick to a short list of popular solutions. More coverage of VistA successes in major pubs creates its own buzz which may encourage IT leaders to reconsider their existing plans.

* VistA consulting firms need to become more common: Right new there are a few firms, like Medsphere, that will walk hospitals through the VistA installation process. But what if, say, Accenture had a division devoted to VistA support?

There’s not a lot you can do if a hospital CEO is determined to buy Epic or Meditech or Cerner. But if they want to consider VistA, there’s a lot the industry could do to help.

Using EMRs To Track Providers

In this blog, we spend a lot of time talking about how EMRs should be used by clinicians. Today, though, I offer you a twist: how hospitals can use EMRs to examine how providers perform. In a nice analysis, Melissa Outlaw of SEERHealth lays out some ways in which hospitals can zoom in on physician productivity and quality by tracking key EMR stats.

One metric she suggests hospitals track is privilege to procedures performed. If your hospital’s privileging system is linked up to ICD and CPT codes, it can make sure that providers are only performing procedures for which they have permission.

Another useful exercise hospitals can perform with their EMR is to determine, using benchmark data, how well they’re performing the procedures they are privileged to perform. She suggests comparing physicians to their peers, other hospital providers and others in your health system (if relevant), using the following data points:

Number of Cases
Case Mix Index
Morality Rate
Number of Readmissions
Readmission Rates
Average Length of Stay

She also suggests using patient statistics by provider to see what impact providers are having on your organization as a whole, specifically by tracking the following:

Inpatient

Counts by Physician Role (Admitting, Attending, Consultant, Secondary Surgeon, and Surgeon
Top DRGs as Attending
Top Diagnosis Codes as Attending
Top Inpatient Discharge Statuses as Attending
Top Procedure Codes as Surgeon/Proceduralist
ICD-9 Complication Codes

Outpatient

Counts by Physician Role
Top CPT/HCPCS Procedure Codes as Surgeon/Proceduralist
Top Outpatient Discharge Statuses as Attending

This makes tremendous sense from managerial perspective. My concern would be, however, that if they’re not used diplomatically, collecting such stats could give physicians one more reason to resent the presence of their EMR. My feeling is that this is a tremendously valuable way to use EMR data, but one that could blow up politically, so use with care.

EMR Issues To Address In 2013

So, we’re coming up on 2013, dragging many of the issues that dogged 2012 right along with us. My theory is that many of the following are likely to linger through next year as well, though maybe I’m being too cynical.

Here’s my list of ongoing EMR issues that don’t seem to be going away:

* Usability problems: While there are scattered efforts to improve the entire EMR usability model, none rules the industry. So as things stand, clinicians generally dislike (or, let’s admit it, in many cases loathe ) enterprise EMRs hospitals have mortgaged their future to buy.

* Interoperability: With proprietary Epic software ruling a growing percentage of U.S. hospitals, getting true interoperability that fuels HIE growth seems a mere dream at the moment. And even if Epic and it’s “ours is best” philosophy didn’t rule the waves of late, connecting other hospital EMR vendors is at a primitive stage at best.

* Poor compatibility with popular mobile devices: Far too few vendors offer a mobile-native client for their EMR, instead forcing clinicians to cope with the limitations of Citrix compatibility. This state of affairs is terrible for the growth of mHealth, which I think we can agree is a Bad Thing.

* Extremely high cost for enterprise EMR systems: When you’re talking about enterprise software, you’re generally talking about a large price tag. But am I the only one who thinks that vendors are padding the heck out of their prices because Meaningful Use has hospitals under the gun?

* Lack of documented ROI and clinical improvement generated by EMRs: Other than collecting an incentive check, most hospitals don’t seem to know how their EMR will generate money, much less savings or return on investment. And as for a body of well-documented research demonstrating that EMRs can generate better clinical results, we just aren’t there yet.

What other problems do we face this year that are going to remain tough to fix next year? Are any of these problems on the verge of being solved?

Study: EMR ROI Stronger In Low-Income Setting

Well, here’s some information which caught my eye right away. According to a new study published recently in the Journal of the American Medical Informatics Association, EMRs can provide a good return on investment for hospitals located in low-income areas.

In the study, researchers studied the what happened when a tertiary hospital in Malawi implemented an enterprise- wide EMR system. The felt it was important to evaluate an EMR implementation in a low-income area such as this, the authors noted, because such hospitals face obstacles unlike those in more prosperous areas, such as marked supply and staff shortages, which might change the effect of such a system.

To examine the impact of the EMR, researchers looked at three areas: length of stay at the facility, transcription times and lab use. The hospital saved an estimated $284,395 per year in U.S. dollars. By the third year of operation, the EMR started generating a positive ROI, and by five years, it provided net benefit of $613,681, according to FierceEMR.

This is an inspiring study for those who hope to see EMR success stories, as until recently, there’s been little if any information to suggest that EMRs can offer a substantial savings on operations, much less help to generate a profit.

This doesn’t necessarily mean that hospitals aren’t generating savings or even profits by implementing an EMR. As we noted in a previous story, few hospitals are planning for and implementing EMR ROI measures early in the game, according to a recent study from Beacon Partners.

If hospitals don’t dig in and integrate EMR ROI measurements into their strategic planning, it’s not surprising that they aren’t getting the fullest picture of what their systems are delivering. Backward-looking measurements aren’t likely to do as much as measurements built on a hospital’ls entire vision for success. Let’s see what happens when hospitals focus on ROI as a top-of-mind item going forward.

UPMC Sinks $100MM Into Big Data

The University of Pittsburgh Medical Center has announced plans to spend $100 million over five years to create a massive data warehouse, a move which puts it well at the forefront of hospital “big data” efforts.

According to Information Week, UPMC’s data warehouse will bring together clinical, financial, administrative, genomic and other information. The health system has targeted more than 200 data sources across the Medical Center, UPMC Health Plan and other affiliates.

I’ll let Information Week describe the technical set-up:

To collect, store, manage, and analyze the information maintained in the data warehouse, UPMC will use the Oracle Exadata Database Machine, a high-performance database platform; IBM’s Cognos software for business intelligence and financial management; Informatica’s data integration platform; and dbMotion’s SOA-based interoperability platform that integrates patient records from healthcare organizations and health information exchanges. These tools will manage the 3.2 petabytes of data that flows across UPMC’s business divisions.

As to how UPMC plans to use these tools, they’re hoping to do all of the things you might imagine, including genomically-tailored prescribing, population analytics and sophisticated tracking of individual patient data to make predictions about possible risks.

As I see it, UPMC’s efforts highlight both the importance of big data efforts and the downside in making the investment.

On the one hand, you’ve got the benefits. For example, patients will clearly see better outcomes if doctors can use top-drawer analytical tools to predict how treatments will work or know well in advance if a patient’s condition is about to go south. And hospitals will clearly run better if execs get insights into issues that cross clinical and administrative boundaries, such as ED or OR utilization.

On the other, you’ve got the reality that big data projects are prohibitively expensive for all but the best-funded of healthcare organizations, and probably won’t produce returns on investment for several years at best. Average community hospitals won’t be consolidating and analyzing their data this way anytime soon.

Hospitals Behind On EMR ROI Measurements

Buying an EMR is one of biggest investments a hospital IT department is likely to make. To date, however, few hospitals are planning for and implementing EMR ROI measures early in the game, according to a new study from Beacon Partners.

Beacon interviewed more than 300 healthcare leaders about the clinical system performance measures they used for their EMR, as well as the resulting ROI. What researchers found out was that most respondents weren’t happy with their organization’s attempts to measure the ROI on their EMR spend — and that many hospitals aren’t directly measuring ROI at all.

According to healthcare leaders who spoke with Beacon, quality management and IT departments, rather than financial executives, generally institute EMR performance measures. All told, 40 percent of respondents said that they were using performance measures, but only 36 percent were satisfied with the extent to which the data was being used to measure the value EMRs brought to their organization, Beacon reports.

The problem may spring from a lack of planning. According to Beacon’s respondents, less than half (48 percent) of performance measures are determined during planning. In fact, 32 percent of providers said that performance measures were implemented in at least one patient care area post-EMR implementation. Fifty-one percent of respondents said that they would have preferred to implement clinical system performance measures earlier than they had done so.

It’s hard to tell what would deter these healthcare execs — mostly leaders with community hospitals — from demanding more results from their EMR investment. My best guess, though, is that adhering to Meaningful Use guidelines has taken up all of their bandwidth, and that CFOs have been mollified by the promise of incentive payments from the feds.

As the Beacon study suggests, though, healthcare leaders aren’t satisfied with this state of affairs. Vendors, expect to get more searching questions about ROI measurement over the next year or two.

Private Payers Don’t Want To Play Meaningful Use Games

Today, health IT writer Neil Versel tweeted an interesting observation:

@ehrandhit I’m still waiting for a private payer to require the same #meaningfuluse of providers. #CHIME12 #EHR #EMR #HITpol

— Neil Versel (@nversel) October 19, 2012

It is indeed interesting to note that while private payers have encouraged physicians to engage in some forms of electronic communication (notably electronic claims adjudication), they’re not setting up their own mini-Meaningful-Use programs.

Now, they are pushing for business models, such as ACOs and the medical home, which require smart use of EMRs. But to my knowledge, few if any health plans have gotten into a tug of war with with providers as to how they use their EMRs, or offered incentives for using an EMR in any specific way.

There’s clearly a reason for that. So what conclusion can we draw from the lack of Meaningful Use-style demands by payers?

Just this — that payers feel their money is better spent on rewarding positive care outcomes and efficiency.

Pay for performance programs have been in place for quite some time now, and evidence is accumulating that they’re effective. According to the Health Care Incentives Improvement Institute, its Bridges To Excellence-recognized physicians have been found to:

Outperform non-recognized physicians on process measures of quality.
Have fewer episodes per patient and lower resource use per episode.
Have lower average costs per patient and per episode.

Clearly, payers have gotten interested in HIEs; data in the aggregate definitely serves their needs. But when it comes to EMRs, they don’t get as excited. So far, the evidence that EMRs can achieve these kind of quality improvements are scattered at best, though there are some promising signs emerging.

Bottom line, payers don’t seem to care much just how engaged providers are in using EMRs, as long as the provider does enough to make entities like medical homes work. The specifics of how providers use EMRs don’t seem like something they’re worrying about.

I’m not suggesting that Meaningful Use programs are a bad idea — it often takes government to do needful things that the private sector can’t or won’t touch — but the fact that payers aren’t pushing something similar does make you think, doesn’t it?

Study Suggests Most HIEs Aren’t Sustainable

According to an EHR Intelligence piece, most HIEs spend more than $1 million per year on operational expenses. That number is probably well on the low end for regional HIEs with multiple health system partners. All told, I think we can agree we’re talking about a money pit here.

The question is, and has been for many years, whether those investments offer any financial or clinical payback. After all, you can only lay out that kind of money for so long before there’s no business case for the exchange.

Unfortunately, it looks like the answer may still be “no” in many cases, according to the authors of a study appearing in Perspectives in Health Information Management. Of the 96 HIEs that responded to the researchers’ survey, the “vast majority” didn’t have a business model in place that would sustain itself even into the near future.

What’s worse, there’s little evidence that things are due to change anytime soon, the authors write: “The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level.”

Even more troubling is the apparently lack of insight into this state of affairs by HIE leaders, the authors assert. When asked how they measured ROI, the authors apparently got very squishy answers, such as that they “believed” their HIE was showing positive ROI without having any metrics to make this case.

I don’t know about you, readers, but I’ve been following health data exchanges of various kinds since the early 1990s, and this is just depressing. If the government’s strategy in doling out some HITECH dollars to HIEs was to help build the core of the Nationwide Health Information Network, I think it’s pretty much proving to be a bust.

No, I’ll come out and say it: I think the government ought to pour massive funding into building out the NHIN and just get it over with without waiting for the politics and competing priorities of healthcare to gum up the works. At this point, I doubt anything else CAN work.

Epic EMR ROI

I think we are familiar with the HUGE institutions that have selected Epic. The most famous of these is the Kaiser implementation of Epic which started at $1.2 Billion and was projected to cost $4 Billion. Yes, that is Billion with a capital B for an EHR implementation. I haven’t done any in depth research on the average cost of an Epic installation, but I can’t remember seeing one lower than a few hundred million at the least.

As I consider these numbers, the following question keeps nagging at me: What’s the ROI for an Epic installation?

Don’t get me wrong. I already know about the many EMR benefits. Although, billions or even hundreds of millions of dollars is a lot of money to make up.

The problem is that covering the EMR space as long as I have, I have yet to see someone do a ROI analysis of an Epic installation. If there’s one out there that I don’t know about, I’d love to take a look. Maybe Epic has some, but it’s part of their tightly controlled process for selling their EHR. Although, if the ROI was so good, it makes you wonder why they wouldn’t want that information in the public domain.

A part of me wonders if hospital CIO’s really care about the ROI of an Epic EHR install. Epic seems to be similar to what enterprises use to say about IBM: “Nobody ever gets fired for buying IBM.” Do many hospital CIOs see it as “Nobody ever gets fired that buys Epic”?

HIMSS: Hospitals Achieving Meaningful Use Milestones

What Would It Take To Get More Hospitals On VistA?

Using EMRs To Track Providers

EMR Issues To Address In 2013

Study: EMR ROI Stronger In Low-Income Setting

UPMC Sinks $100MM Into Big Data

Hospitals Behind On EMR ROI Measurements

Private Payers Don’t Want To Play Meaningful Use Games

Study Suggests Most HIEs Aren’t Sustainable

Epic EMR ROI

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