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Are We Outgrowing HIM Systems?

Posted on July 15, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

We have changed and adapted to a rapid influx of electronic medical records and data over the last several years and it’s no surprise that some systems have struggled to keep the pace. Electronic medical records (EMRs) are in a state of constant revision to make sure patient care, clinical functionality, and data security measures are keeping up with our needs. It seems there are software application solutions or enhancements to almost every task we do in healthcare and these systems are also constantly evolving.

I don’t know of any healthcare application system or workflow that has remained static year over year and because of this, it is important for us to stay on top of vendors and keep an eye on current and future needs of HIM workflows. Clinical Documentation Improvement (CDI) is one of those areas that has been evolving since it first came on the scene and it is currently undergoing yet another face-lift. We realized there were many revenue opportunities hiding within inpatient clinical documentation and found that we could maximize reimbursement with a little detective work and physician education along with sophisticated software tools. Many are exploring the idea of CDI for outpatient levels of care. This means we will need software applications, interfaces, and expanded CDI workflows to extend these opportunities to outpatient documentation. Have you thought about what you will need from your vendors to adapt or upgrade current systems and how much will need to be budgeted for?

As we work to implement computer assisted coding (CAC) programs, we see opportunities to increase coder and CDI productivity and capture even more quality documentation by using discrete EMR data to our advantage. But are these CAC systems ready to be pushed to the limits to enter unchartered waters? I personally do not have a CAC success story to tell as of yet, but I am exploring the options and hoping that these systems have matured more than when we first explored them a few years ago.

That’s the beauty of technology in healthcare; if a product does not meet your needs, there may be other options already on the market or rapidly developing new technologies on the horizon. A vast amount of data may be held hostage in our systems if we do not maximize our EMRs and applications and set our standards high in a quest for knowledge. We can’t rely 100% on technology to dictate what we do which is why we need to be the visionaries and demand more from our systems in order to accomplish new and exciting things in HIM.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

EMR Vendors Slow To Integrate Telemedicine Options

Posted on August 27, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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. She can be reached at @ziegerhealth or

Despite the massive growth in demand for virtual medical services, major EMR vendors are still proving slow to support such options, seemingly ceding the market to more agile telemedicine startups.

Independent telemedicine vendors targeting consumers are growing like weeds. Players like Doctor on Demand, NowClinic, American Well and HealthTap are becoming household names, touted not only in healthcare blogs but on morning TV talk shows. These services, which typically hire physicians as consultants, offer little continuity of care but provide a level of easy access unheard of in other settings.

Part of what’s fueling this growth is that health insurers are finally starting to pay for virtual medical visits. For example, Medicare and nearly every state Medicaid plan also cover at least some telemedicine services. Meanwhile, 29 states require that private payers cover telehealth the same as in-person services.

Hospitals and health systems are also getting on board the telemedicine train. For example, Stanford Healthcare recently rolled out a mobile health app, connected to Apple HealthKit and its Epic EMR, which allows patients to participate in virtual medical appointments through its ClickWell Care clinic. Given how popular virtual doctor visits have become, I’m betting that most next-gen apps created by large providers will offer this option.

EMR vendors, for their part, are adding telemedicine support to their platforms, but they’re not doing much to publicize it. Take Epic, whose EpicCare Ambulatory EMR can be hooked up to a telemedicine module. The EpicCare page on its site mentions that telemedicine functionality is available, but certainly does little to convince buyers to select it. In fact, Epic has offered such options for years, but I never knew that, and lately I spend more time tracking telemedicine than I do any other HIT trend.

As I noted in my latest broadcast on Periscope (follow @ziegerhealth), EMR vendors are arguably the best-positioned tech vendors to offer telemedicine services. After all, EMRs are already integrated into a hospital or clinic’s infrastructure and workflow. And this would make storage and clinical classification of the consults easier, making the content of the videos more valuable. (Admittedly, developing a classification scheme — much less standards — probably isn’t trivial, but that’s a subject for another article.)

What’s more, rather than relying on the rudimentary information supplied by patient self-reports, clinicians could rely on full-bodied medical data stored in that EMR. I could even see next-gen video visit technology which exposes medical data to patients and allows patients to discuss it live with doctors.

But that’s not how things are evolving. Instead, it seems that providers are largely outsourcing telemedicine services, a respectable but far less robust way to get things done. I don’t know if this will end up being the default way they deliver virtual visits, but unless EMR vendors step up, they’ll certainly have to work harder to get a toehold in this market.

I don’t know why so few EMR companies are rolling out their own virtual visit options. To me, it seems like a no-brainer, particularly for smaller ambulatory vendors which still need to differentiate themselves. But if I were an investor in a lagging EMR venture, you can bet your bottom dollar I’d want to know the answer.

Key Big Data Challenges Providers Must Face

Posted on July 17, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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. She can be reached at @ziegerhealth or

Everybody likes to talk about the promise of big data, but managing it is another story. Taming big data will take new strategies and new IT skills, neither of which are a no-brainer, according to new research by the BPI Network.

While BPI Network has identified seven big data pain points, I’d argue that they boil down to just a few key issues:

* Data storage and management:  While providers may prefer to host their massive data stores in-house, this approach is beginning to wear out, at least as the only strategy in town. Over time, hospitals have begun moving to cloud-based solutions, at least in hybrid models offloading some of their data. As they cautiously explore outsourcing some of their data management and storage, meanwhile, they have to make sure that they have security locked down well enough to comply with HIPAA and repel hackers.

Staffing:  Health IT leaders may need to look for a new breed of IT hire, as the skills associated with running datacenters have shifted to the application level rather than data transmission and security levels. And this has changed hiring patterns in many IT shops. When BPI queried IT leaders, 41% said they’d be looking for application development pros, compared with 24% seeking security skills. Ultimately, health IT departments will need staffers with a different mindset than those who maintained datasets over the long term, as these days providers need IT teams that solve emerging problems.

Data and application availability: Health IT execs may finally be comfortable moving at least some of their data into the cloud, probably because they’ve come to believe that their cloud vendor offers good enough security to meet regulatory requirements. But that’s only a part of what they need to consider. Whether their data is based in the cloud or in a data center, health IT departments need to be sure they can offer high data availability, even if a datacenter is destroyed. What’s more, they also need to offer very high availability to EMRs and other clinical data-wrangling apps, something that gets even more complicated if the app is hosted in the cloud.

Now, the reality is that these problems aren’t big issues for every provider just yet. In fact, according to an analysis by KPMG, only 10% of providers are currently using big data to its fullest potential. The 271 healthcare professionals surveyed by KPMG said that there were several major barriers to leveraging big data in their organization, including having unstandardized data in silos (37%), lacking the right technology infrastructure (17%) and failing to have data and analytics experts on board (15%).  Perhaps due to these roadblocks, a full 21% of healthcare respondents had no data analytics initiatives in place yet, though they were at the planning stages.

Still, it’s good to look at the obstacles health IT departments will face when they do take on more advanced data management and analytics efforts. After all, while ensuring high data and app availability, stocking the IT department with the right skillsets and implementing a wise data management strategy aren’t trivial, they’re doable for CIOs that plan ahead. And it’s not as if health leaders have a choice. Going from maintaining an enterprise data warehouse to leveraging health data analytics may be challenging, but it’s critical to make it happen.

Is Epic Too Big To Fail?

Posted on May 27, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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. She can be reached at @ziegerhealth or

While there’s a chance an Epic purchase can endanger a hospital’s financial health, I’ve never heard a whisper of gossip suggesting that Epic is in financial trouble.

In fact, it appears virtually unstoppable. Though Epic is a private company, and doesn’t disclose its financial information, its 2014 revenue was estimated at $1.75 billion, up from $1.19 billion in 2011. And despite the fact that the hospital EMR market is getting saturated, the giant EMR vendor is doing quite nicely with the estimated 15% to 20% of the market it is reported to hold.

Still, what would happen if Epic took a body blow of some kind and stopped being able to support the implementation and operation of its products?  After all, buying an EMR isn’t like picking up, say, a fleet of trucks that the hospital services and maintains. For years — sometimes a decade — after a hospital goes with Epic, that hospital is typically reliant on Epic to help keep the EMR lights on.

Which brings me to my core question: Is Epic too big to fail? Would it create such a disaster in the healthcare market that the U.S. government should step in if Epic ever had a massive problem meeting its commitments?

As little as I like saying so, there’s a strong argument to be made that Epic simply can’t be allowed to stumble, much less crumble.

As of April 2014, Epic reportedly had 297 customers, a number which has undoubtedly grown over the past year. What’s more, 70% of HIMSS Analytics Stage 7 hospitals, i.e. hospitals for which their EMR is absolutely mission critical, use the EpicCare inpatient EMR.

If Epic were to face some financial or operational disaster that prevented it from supporting its hospitals customers, those hospitals would be very compromised. Epic’s customers simply couldn’t leap abruptly to, say, a competing Cerner system, as the transition could take several years.

Depending how far along in their Epic install and launch they were, hospitals might try to limp along with the technology they had in place, switch temporarily to paper records or try to keep their progress going with whatever Epic consultants they could find.

In an effort to recover from the loss of Epic support, hospitals would be forced to bid high for the services of those consultants. Hospitals could have their IT budgets decimated, their credit harmed or even be driven out of business.

In the crazy shuffle that would follow, there’s little doubt that many medical errors would occur, some serious and some fatal. It’s impossible to predict how many errors would arise, of course, but I think it’s easy to argue that the number would be non-trivial.

Given all this, the feds might actually be forced to step in and clean up Epic’s mess if it made one. Mind you, I’m not saying that, say, HHS has such a plan in place, but perhaps it should.

Ultimately, I think the healthcare industry ought to do some self-policing and find some ways to reduce its reliance on a single, frighteningly-powerful vendor. Over time, I believe that will involve gradually shifting away from reliance on existing EMRs to next-gen EMRs built to support value-driven payment and population health analysis. In the mean time, we’d better hope nobody drops a giant rock on Epic’s executive headquarters.

Four Things You Should Know About Deloitte’s “Evergreen” EHR Program

Posted on February 20, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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. She can be reached at @ziegerhealth or

Recently, consulting giant Deloitte announced a new program, named “Evergreen,” designed to cut down the cost of implementing and operating hospital EHRs. Unfortunately, much of the Evergreen coverage in the health IT trade press was vague or downright wrong, as it suggested that Deloitte was actually going into the EHR business itself. The key point Deloitte sought to make — that it could implement and operate EHRs for 20% to 30% less than hospitals — did come across, but the rest was a bit jumbled.

Having spoken to Mitch Morris, global healthcare leader for Deloitte Consulting LLP, I can clarify much of what was confusing about the Evergreen announcement and subsequent coverage.  Here’s some key points I took away from my chat with Morris:

  • Evergreen is a suite of services, not a product:  Though some HIT editors seem to have been confused by this, Evergreen isn’t an EHR offering itself.  It’s a set of EHR implementation and operation services provided by Deloitte Consultants. Evergreen also includes a financing scheme allowing hospitals and health systems to obtain a new EHR by making a series of equal payments to Deloitte over five to seven years. (“It’s like leasing a car,” Morris noted.) This allows hospitals to get into the EHR without making an enormous upfront capital investment over the first 18 months.
  • Evergreen is only offered in tandem with an Epic purchase:  The Evergreen program arose from what Deloitte learned after doing a great deal of work with Epic EHRs, including the famous multi-billion install at Kaiser Permanente and an extensive rollout for large hospital system Catholic Health Initiatives. So at the outset, the program is only available to hospitals that want to go with Epic.  Deloitte is considering other EHR vendors for Evergreen partnership but has made no decisions as to which it might add to the program.
  • Both onshore and offshore services are available through Evergreen:  One might assume that Deloitte is offering lower implementation and operation costs by offshoring all of the work.  Not so, Morris says. While Deloitte does offer services based in India and Ireland, it also taps U.S. operations as needed. Clients can go with offshore labor, onshore labor or a mix of services drawing on both.
  • This is a new application services management offering for Deloitte:  While the consulting giant has been managing Oracle and SAP installations for clients for some time, managing EHR platforms is a new part of its business, Morris notes.

According to Morris, Deloitte expects Evergreen customers to include not only health systems and hospitals that want to switch EHRs system-wide, but also those which have done some acquisitions and want to put all of their facilities on the same platform. “It’s expensive for a health system to maintain two or three brands, but they often can’t afford the upfront capital costs of putting every hospital on the same EHR,” he said. “We smooth out the costs so they can just make a payment every month.”

This could certainly be a big score for Epic, which is likely to scoop up more of the EHR-switching systems if Deloitte helps the systems cope with the costs. And Deloitte is likely to get many takers. Let’s see, though, whether it can actually follow through on the savings it promises. That could change the EHR game as we know it.

Healthcare IT Consulting Job Slowdown

Posted on December 1, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A recent poll on HIStalk, caught my eye. In the poll he asked readers “For health systems: how much IT related consulting will you use in 2015 vs. 2014?” Here’s an image of the responses:
Healthcare IT Consulting

It seems only fair to acknowledge that this wasn’t a deep study. It was an online poll with plenty of potential sample bias. Plus, it only had 107 respondents to the poll. Especially with it being an online poll, I’d have liked to see more respondents. However, it’s worth noting that 50% of those who did respond are planning to use less healthcare IT consulting in 2015. Although, just as surprising is that 14% plan to use more health IT consulting.

This was somewhat expected from my point of view. The consulting market just exploded over the past couple years as hospitals raced to implement an EHR and show meaningful use. As that program has started to mature, there isn’t as much need for consultants. So, it’s no surprise that the government incentivized EHR consulting market would contract back down to a more reasonable market.

That’s not to say that there aren’t still lots of opportunities for EHR consulting still. In fact, I’d argue that the opportunity for EHR consulting has never been bigger. It’s the EHR staff augmentation companies which often dress up as EHR consultants that are likely taking the hit. My feeling is that EHR staff augmentation is way down and EHR consulting is going to continue trending up. All of these hospitals need to start maximizing their EHR investment. That requires a consultant as opposed to more hands on deck for the EHR go-live.

We’re currently seeing this play out on the Healthcare IT Central job board. The type of jobs that are being posted are much more advanced. Plus, we’re seeing a maturing of EHR adoption and that’s shifting towards more full time EHR staff vs consulting.

What are you seeing in the market? Are you using more health IT consultants or fewer? Where do you see the industry headed?

Finding the Right IT Skills – Guidelines for Health IT Outsourcing

Posted on November 26, 2014 I Written By

The following is a guest blog post by James Caw,marketing manager at Sebrio Consulting.
James Caw
With the HITECH Act, Meaningful Use and Accountable Care requiring more and more attention from HealthCare organisations throughout the United States, the demand for experienced software developers, integration experts and industry focused software companies is rapidly expanding.

In a season of record unemployment and shrinkage in the job market, these government driven programs have created a welcome and unique windfall of job opportunities for those with relevant HealthIT skills. Unfortunately with great demand, comes a rising cost and unfortunately a shortage of relevant skills. HealthCare organisations cannot meet their requirements from the limited available resources in the market.

I read an article just last week about US HealthCare job numbers. While it is still the fastest growing sector in the US, the writer showed that the distribution of job adverts had shifted considerably. No longer are nurses, doctors and clinicians at the top of the demand list. No, while those positions are still being advertised, the large majority of active posts are now software development, integration or IT support roles.

A recent discussion at a Boston based Health conference followed a similar line. The Health CIOs and Chief Medical Officers present described the pressure that interoperability and the demands of Meaningful Use and Accountable Care were placing on their resources. The EHR systems are installed and capable of delivering the required data, but the volume of interfaces, integrations and applications required was out of their reach without a large influx of additional IT skill.

This problem has been building for some time. A study published at the start of 2014 by PWC showed that, in 2013, as many as 34% of health care Chief Executives had delayed a significant strategic project or implementation due to insufficient IT staff resources.

While this may not seem too significant a number on first glance, add to this the compounded effect of the same problem across various states and over a number of years. The result is that many organisations are facing the same challenge and are missing their Meaningful Use and Accountable Care goals. And missing those goals has significant financial repercussions.

There is some relief, and many executives have begun to embrace an additional model of delivering solutions to their organisation. Outsourcing specialist projects not only cross-county, but also cross-continent. The HealthIT industry is a global one, with skill and knowledge spread out all over the world. Activating this external pool of resources is enabling many healthcare organisations to reach their goals on time and no longer delay those key strategic initiatives.

The challenge in outsourcing has always been finding experts with local knowledge, relevant industry exposure and practical working experience around messaging standards and compliance challenges. Solution providers do exist in this space and, as one of these, I’ve compiled some guidelines for selecting a potential partner for your HealthIT projects.

  • Look for longevity – A solutions provider must have a track record of service delivery. There are many companies who have been trading for under a year and have little or no relevant experience.
  • Check for commendations and/or memberships and certifications from a credible authority – A company with “InterSystems experience” and an “InterSystems Partner” are two very different claims. Find these claims and test them with the relevant company.
  • Ask for a Show Case document or Company Profile. – A services company should be able to tell you which projects they’ve worked on (assuming the work is not protected by a Non Disclosure Agreement).
  • Seek diverse skills within one company – The health information management market is incredibly diverse. A partner should understand integration, local standards and legal requirements in your market. A diverse array of technologies are in play, and a company with too narrow a focus may not make use of the best available technology to deliver a solution to your challenge.
  • Ask for references, and follow those up – In a world as complex as health care, there are many areas of expertise. Ask for credible references and then make sure to call or email the correct people at credible institutions and seek their honest opinion on the company in question.
  • Sign a non-disclosure agreement – This is general best practice. In HealthIT projects, the data is highly confidential and even the workflows can be a result of years of careful planning and experience. A non-disclosure is an important and vital part of the invitation to engage.
  • Start small – If your backlog is growing rapidly, you may be tempted place a large project with an identified external company. While there is no reason to assume that they cannot handle the task, there is wisdom in building the relationship and setting the foundation first. A small project which adds value to your organisation, such as a new interface build, a user interface, a minor integration or a messaging project, will introduce your solution provider to your internal team, work structure, policies and nuances and give you the opportunity to test their skill, capabilities, understanding and claims.
  • Build a relationship and grow gradually – Focus on communication and once you know you can work together successfully, gradually increase the significance of the projects. Now is the time to clear that backlog together.

The US has an immense shortage of HealthIT skill. A credible and practical solution is available and one of the solution providers out there may be the best fit for your organisation. As with all relationships, it’s a great tactic to start slowly. Test it first and if it doesn’t work out, say goodbye politely and seek that next engagement. Perhaps you’ll find, as we certainly have, partners that can meet your needs on an ongoing and mutually beneficial basis.

About James Caw
James Caw is the marketing manager at Sebrio Consulting, a well regarded software services company with 10 years of HealthIT experience. As the only InterSystems dual Technology and Implementation Partner in Southern Africa, Sebrio works remotely in the US and has been adding value to projects from minor integrations to state-wide health information systems. Sebrio is growing rapidly and can be found on Twitter @SebrioSoftware or at their website: