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Sutter Health Ready To Deploy HIE, But Can It Succeed?

Posted on June 30, 2014 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Sutter Health doesn’t have a great reputation when it comes to EMR implementation. Late last year, when we reported that Sutter’s Epic EMR crashed for an entire day, comments came pouring in about the company’s questionable approach to training its staff on using the system.

According to Epic consultants who’d been involved in the project, Sutter leaders decided that Epic experts were there to “facilitate” training done by inexperienced in-house teams, rather than actually teach key users what they need to know. The result was strife, disorder and anxiety, according to several consultants who’d been involved. Since then, Sutter has connected its EMR to five medical foundations and 17 hospital campuses; by next year, it expects the EMR to connect to information on 3 million patients. But there’s no reason to think it’s changed its training strategy, which could cast a bit of a pall over the new project.

Now, Sutter Health is building out a health information exchange, working with Orion Health, which will tie together hospitals and doctors both inside and outside of its network across northern California. Sutter plans to begin deploying the HIE in phases this summer, starting with data integration with the Epic EMR and extending to testing exchange of inbound and outbound data. If the project works out, it seems likely that it will be a plus for every provider that does business with Sutter.

The question is, will Sutter do a better job of managing this process than it did in rolling out its EMR? While it’s easy to boast that your plans are going to be a “gamechanger” for the market, it’s hard to take that claim at face value when your EMR implementation hasn’t gone so splendidly.

Certainly, Orion is a reputable HIE vendor which has been praised for having strong products and service. And Sutter certainly has the financial wherewithal to see such an effort through. The thing is, if Sutter leaders (seemingly) took a wrongheaded approach to the all-important issue of EMR training, who knows what curveballs they might throw into the process of rolling out an HIE? Even if its EMR has stabilized and Sutter has somehow gotten past its training hurdles, its past missteps don’t inspire confidence.

If I were with Orion, I’d draw a firm line where training was concerned, as Sutter’s past strategy only seems to have cast its last major HIT vendor in a bad light. If not, I’d make sure the contract had a workable bailout clause…or be prepared for some serious headaches.

Ohio HIE Hits 101-Hospital Mark

Posted on September 12, 2013 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This is a very busy time for HIE builders.  In recent months several states have either announced that they’d completed their preparations for a broad-based HIE or reached a new milestone in HIE participation.

For example, earlier this month the state of Wisconsin announced that it is gearing up to kick off a statewide HIE network that would embrace hospitals, clinics, nursing homes and other care facilities, powered by HIE technology vendor Medicity.

According to Health Affairs, this is part of a larger trend. A recent piece in the journal noted that health data exchanges between hospitals and other healthcare providers have climbed 41 percent between 2008 and 2012.

The latest in state HIE news comes from Ohio, where the state’s HIE has just announced that it had signed two hospitals, 25 bed Harrison Community Hospital in Cadiz as well as 91-bed Wilson Memorial Hospital in Sidney, reports Healthcare IT News.  With the new additions, Ohio’s CliniSync HIE now boasts 101 of the state’s hospitals.

CliniSync, which is run by the nonprofit Ohio Health Information Partnership, is based on Medicity technology as well.  With these new members, and the momentum it has underway, CliniSync might well be one of the largest public HIEs in the U.S. by 2014, Healthcare IT News reports.

According to Healthcare IT News, CliniSync makes it possible for physicians, hospitals, nurses and others who do patient care to share patient data electronically. What’s really neat, if true, is that CliniSync will allow doctors and hospitals with varied EMRs to share data. Previously, the HIE members could only share data regionally or within their own systems.

Adolescent Data Needs Stronger EMR Protections, Group Says

Posted on November 13, 2012 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The American Academy of Pediatrics is calling for changes to EMRs to protect the privacy of adolescent patients, whom, it says, don’t currently get the same level of protection as adults.

According to the AAP, there are several reasons adolescents don’t enjoy the same privacy protections as adults.

For one thing, there are the legal issues. HIPAA doesn’t provide specific guidance on adolescent privacy, and the medical industry hasn’t put clear standards in place outlining when adults can access an adolescent’s health records either.

What’s more, states vary in how they handle this issue, according to the AAP report. State laws typically allow minors to consent for their healthcare on the basis of their status — for example, if they’re a pregnant or parenting teen — and on the basis of the services they seek  — such as STI diagnosis and treatment or contraception. However, while state and federal laws provide protection of privacy when minors  consent for their own care, privacy protections differ widely.

To make sure adolescent privacy is protected across all data platforms, the AAP is recommending a set of principles that it feels should ideally govern not only EMRs, but also PHRs and HIEs. These include :

*  Creation of a set of criteria for EMRs that meet adolescent privacy standards

*  Creating and implementing technology for EMRs which would allow determination of who has access to, or ability to control access to, any part of the adolescent medical record.

* Making it possible for adolescents to record consents and authorizations according to privacy laws using the HL-7 Child Health Profile DC.1.3.3 standard

*  Flexibility within standards to allow for protection of privacy for diagnoses, associated lab tests, problem lists and any other documentation containing confidential data.

* EMR systems must be able to apply state and federal confidentiality rules when assembling aggregate data to prevent identification of individuals.

The AAP has a lot more to say, but in summary, it seems to be putting the burden for protecting adolescent privacy largely on EMR vendors, though I believe it’s hoping members will advocate for these changes as well.

Either way, it doesn’t work well if there’s a protected class (certain adolescents) whose rights simply can’t be protected adequately with today’s technology.  Time to get on this issue, I’d say.

Providers Behind The Eight Ball On HIEs

Posted on October 4, 2012 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

ONCHIT is demanding them. Patients are beginning to understand them. But poor ol’ beleaguered HIEs still aren’t getting the attention they deserve, it seems.

A new survey by patient care organization ECRI Institute, done with strategic partner s2a, has concluded that while they understand the importance of HIEs, only 54 percent of providers have formally assessed their HIE and interoperability needs. (See the study here.)

Given the speed at which Meaningful Use data exchange requirements are barreling down on providers, that seems like a pretty low number to me.  After all, the final rule for MU Stage 2 requires providers to at least be able to electronically transmit a Summary care record using a certified EMR system or HIE for 10 percent or more of care transitions and referrals.

It’s also a pretty low number given that 93 percent of hospitals surveyed agreed that interoperability of health systems was one of their top strategic priorities.  Provider CIOs are well aware that getting HIE connectivity in play is a long and difficult process, and while they can’t do everything at once, one would assume that most providers would have a team in place to at least begin the assessments by this point.

The ECRI analysts conclude that two major factors are holding providers back:

*  Working with non-employed physicians:  For the moment, hospitals are focused largely on interoperability with their employed physicians, who typically use the same EMR as the facility does. Working with non-employed physicians is a major challenge for many reasons, including that they typically aren’t using the same EMR as the hospital.  There’s also legal issues that come into play: for example, what happens is non-employeds end up sharing data intended for Hospital B with Hospital A?

* Medical device connectivity:  Meaningful Use is putting great pressure on hospitals to exchange information between medical devices and EMRs.  However, interoperability even between a blood pressure cuff and and EMR is no picnic.  ECRI found that 40 percent of respondents hadn’t established policies and procedures for EMR interoperability with medical devices.

Of course, the sheer work and expense involved in becoming an HIE participant is immense, as well. Given those expenses, time demands, and the issues in connecting with physicians, I have to believe that a fair number of hospitals won’t be ready when Meaningful Use Stage 2 requirements hit.

Hospitals Plan HIE Spending Binge, But Are They Prepared?

Posted on September 17, 2012 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s some stats that wowed me, and may surprise you too. It looks like hospitals, under pressure to move towards meeting Meaningful Use Stage 2 expectations, are finally barreling into investments in HIE technology.

According to a new study by CapSite, 71 percent of hospitals  surveyed plan to purchase new HIE technology, and 50 percent have joined a private, state or regional HIE. The CapSite 2012 U.S. Health Information Exchange Study, which surveyed about 370 hospitals on their plans, noted that these stats show an uptick from 2011, where they found that one-third of hospitals had joined an HIE.

Why do these stats seem remarkable to me?  Well, for one thing, they’re spending a lot of money to do something nobody seems to know how to do well. To quote a previous story for this blog:

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.

It’s not that there aren’t roadmaps for hospital HIE builders to consider. Earlier this year, for example, the National eHealth Collaborative and IDC Health Insights released reports offering best practices HIE builders should consider.

But if you look closely at these recommendations, as well as others made by analysts and policy makers, it appears the HIEs are going to have to get past lots of political obstacles. The NeHC’s step one, “reaching a consensus with regard to objectives and vision for the exchange” could be a real trial in and of itself.  Getting to the point where hospitals share governance effectively with other bodies, deal with competitive issues and handle interoperability — well, I’m not going to hold my breath.

So, while HIE fans (and vendors, natch) are likely to be cheered by this report, I’m calling this out as a potential disaster. Hospitals, are you really ready to spend HIE money wisely?

What Won’t Happen In #HIT By September 2013

Posted on September 7, 2012 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As part of the upcoming National Health IT Week (#NHITWeek), which takes place September 10 through 14th) my august colleague John has written up a list of ways in #HIT is likely to make a difference over the next 12 months.  (He makes some great guesses; definitely give the post a look.)

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?”  Here’s some of my predictions:

* EMR-to-EMR interoperability:  Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

High penetration by HIEs:  With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

Major uptick in open-source HIT  use:  Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

Epic controls the hospital EMR world for good:  Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak.  But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring:  Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs.  I just think we’re going to remain stuck with some of these legacy issues for some time to come.

5 Mistakes Healthcare Vendors Make in Tracking Customer Satisfaction

Posted on August 17, 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 13 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Chris O’Neal is Managing Partner at KATALUS Advisors. KATALUS Advisors is a strategic consulting firm focused on the healthcare vertical. We serve healthcare technology vendors, hospitals, and private equity groups in North America, Europe, and the Middle East. Our services span growth strategies in new and existing markets, M&A due diligence, market analysis, and advisory services. www.KATALUSadvisors.com

A lot of our work revolves around helping our healthcare vendor clients engage with their customers, specifically to track satisfaction and loyalty. We have seen what passes for customer research in the industry, and while the efforts are commendable, the execution typically leaves a lot to be desired. There are five common mistakes we regularly see healthcare vendors make in their customer loyalty programs:

  1. Survey Fatigue: Most companies use lengthy, complex surveys which just take too much time. Also, providers get hit with a lot of survey requests. These two concerns induce low response rates and poor data quality.
  2. Low Response Rates: Many structured survey programs yield single-digit response rates. If this is the case for your program, you need to rethink the entire process, from how you notify your customers to the tools you are using to gather information. Getting more of your customers engaged is as much about process as it is about product.
  3. Low Frequency: Given the effort required to conduct a wide-ranging customer satisfaction poll, most vendors who do so usually engage once a year, or twice a year tops. Too many things are happening in your customer base in the intervening six or twelve months to stay out of touch.
  4. Lack of Consumability: Typically, it takes weeks and months for a customer research program to turn around the results of the campaign. To be truly effective, the information needs to be as close to real time as possible. That means making the data immediately available and consumable for decision makers as it comes in, not after the fact.
  5. Lack of Closing the Loop: Few customer research programs provide an effective means for applying the results in a way that positively and quickly impacts the customer experience.

Savvy vendors are finding ways to avoid these common mistakes. These companies understand that engaging customers in a consistent, meaningful manner must be a corporate focus, not an afterthought. And customer satisfaction is only becoming more important for hospitals as well, as requirements around patient engagement and similar initiatives will likely be part of the ACO model.

Top HIS Vendors By 2011 Revenue: McKesson Corp. (MCK)

Posted on April 16, 2012 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Knowing which vendors have the highest revenue doesn’t have an immediate impact on your HIS installation, but somehow it’s fascinating anyhow.  Besides, knowing who’s solvent and what projects they’re pursuing never hurts.

So over the next few weeks, we’re going to share the names and details on the five top earners isolated by HealthData Management magazine, with some details on what they sell, how they’re doing revenue wise and whenever we can, what their market position is. Be sure to check out our full list of Top HIS Vendors.

Bear in mind that by HDM’s definition, we’re talking about vendors who cut across the whole suite of HIS services, from EMRs to revenue cycle management and departmental applications.  In most cases, the article hasn’t broken out EMR revenue from its overall revenue projections for each company.  But that being said, there’s still some really interesting data here.  All estimates are from sources indicated, as compiled by HDM.

Anne

McKesson Corp.
One Post Street
San Francisco, CA 94104
415.983.8300

McKesson is a $112 billion public company (MCK: NASDAQ) with a hand in most key healthcare sectors. There’s  medical supply and pharmacy distribution, HIT solutions which include an EMR and a clinical decision support system, pharmacy automation and medical claims management software….you get the picture. We’re talking a scary big octopus here.

While it continues to be a pharmacy giant, one has to wonder whether McKesson will shift more effort and dollars into HIT when you consider this stat: HIT generated an estimated 44 percent of  the company’s profit last year, though it accounted for less than 1 percent of its revenue. Wow.

2011 HIS Revenue: $3.2 billion

2010 HIS Revenue:  $3.12 billion

Interesting fact:  Believe it or not, MCK has been in business for 175 years; It began as a medical goods supplier in Ye Olde Days.

Tampa Hospitals, Physicians In Tug Of War Over RHIO

Posted on April 4, 2012 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Sometimes, RHIOs fail to gel or fall apart because of technical issues. But in one Florida community, it seems like pure politics may doom efforts by area doctors and hospitals to connect.

According to the Tampa Tribune, there’s a tug-of-war going on between the Hillsborough Medical Association and a consortium of local hospitals over how providers in the Tampa Bay area will share data.  Hospitals want doctors to follow their lead, not too surprising given how much they’ve probably invested in big-ticket systems like Epic.  The medical association, meanwhile, is arguing that its members are a better choice to coordinate things, since they have more frequent contact with patients and know them better.

The crux of the matter seems to be this.  HITECH may have laid out a lot of money to encourage EMR adoption, but the feds haven’t spelled out who should control the HIEs binding them together.  As a result, nobody seems to agree on how to build and share a medical information exchange.

So now it’s come down to a matter of statistics, financial and organizational.  A group of seven hospitals would like to lead a RHIO, driven by their knowledge of integration and data exchange they’ve spent tens of millions of dollars to acquire. The hospitals are currently shopping for a medical data exchange technology vendor and estimate it could take 18+ months before data exchange between hospitals gets rolling.

Meanwhile, the medical association is more interested in a north Florida group, Big Bend RHIO, which is operated in part by the Florida Medical Association. Big Bend RHIO has won the support of some of the region’s largest medical practices, the Tribune reports, and represents more than 1000 doctors.

Yet another option is for local hospitals to sign on to a statewide HIE managed by Harris Corp., which got a $19 million grant to create the exchange two years ago. Some hospitals and doctors are asking whether it might not be better to jump on board with the Harris project (something that sounds pretty sensible to your editor).

My guess: it will be preeeetty darned close to 2015 before these folks figure out how to work together.  It’s a pity there’s no simple technology for ego information exchange.

Hospital Mergers Make HIE Integration Even Tougher

Posted on February 8, 2012 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 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In the fantasy world of shared healthcare data, all hospitals will gradually join HIEs, share data regionally and then nationally, and patient care will substantially improve. Or at least hospitals will be in a better position to avoid errors due to critical missing information.

Sure, that’s already happening in some regions of the country. For examples, check out the list of rock-solid HIEs identified by the National eHealth Coalition, including Rochester RHIO, MedVirginia and Availity, all interesting in their own way.

But at the same time, hospitals continue to merge and sell out to larger health systems, in some cases at an almost manic pace. I don’t have the space to list even a few of the mergers that are dominating business coverage, but I’m sure you know of one in almost every market where you work or have business.

These mergers will frequently bring together different EMRs, or even the same EMR configured differently. Not only that, within each hospital, in all likelihood the EMR will have been integrated with internal departments and systems differently. In other words, even two Epic systems aren’t going to marry up easily.

What’s more, when a well-funded hospital buys one in desperate financial straits, which is often the case, what’s the odds the smaller will have a costly Epic or Cerner or Meditech system in place? Not very high, I reckon. So the systems integration problem is even worse. Now, doubtless a large, well-funded system will ultimately put their system of choice in place eventually, but that won’t happen overnight.

So, as merger activity proceeds apace, it’s creating islands of discord and disconnected data. And my best guess is that those hospitals won’t be HIE-ing anytime soon, though I may be off base here.

I do have some hope that the Direct Project will be able to work around some of these obstacles. Though it’s still at the pilot stage, and participants are sharing only a small subset of clinical data, it does seem promising. I’m particularly intrigued by the notion of a HISP (Health Information Service Provider) which helps to push information from one provider to another.

Let’s hope that models like the Direct Project continue to emerge. Otherwise, the Tower of Babel we’ve got is likely to keep babbling.