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

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.

June 30, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Hospitals Need to Diversify – What’s It Mean for EHR?

In a recent article on Health CXO, they made the following comment:

In the report “Building Value: Investments Aimed at New Priorities Create Opportunities for Not-For-Profit Hospitals,” experts at the New York-based financial firm note that the decline in inpatient volumes seen over the past several quarters is no fluke but rather a long-term trend driven by health reform. This means that hospitals that want to remain successful need to look beyond just inpatient services and become full-service health systems that are able to follow the patients to the lower cost and frequently higher value outpatient setting. [emphasis added]

This trend is definitely worth noting. We’ve discussed the acquisition of outpatient clinics a number of times, but never the trend of declining inpatient volumes. The article suggests that the key to viability for a hospital will be to diversify into outpatient services. I’m not sure all hospitals want to become full-service health systems and so it will be interesting to see how this plays out.

Assuming this trend continues, I’ll be interested to see what this means for a hospital’s EHR strategy. Will they go with the one big EHR across their hospital and ambulatory environment? If you look at these recently posted EHR market share statistics, you can see that this method is happening a lot. As the deals get larger, I think we’ll see push back against moving to one unified EHR software. That presents an interesting opportunity for what Alan Portela and Airstrip are doing. Not to mention the need for a private HIE.

May 27, 2014 I Written By

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

Time for Government to Step Out of the Way of EHR and Let the Market Takeover?

The always interesting and insightful John Moore from Chilmark research has a post up that asks a very good question. The question is whether it’s time for the government to get out of the EHR regulation business and let the market forces back in so they can innovate. I love this section of the post which describes our current situation really well:

But as often happens with government initiatives, initial policy to foster adoption of a given technology can have unintended consequences no matter how well meaning the original intent may be.

During my stint at MIT my research focus was diffusion of technology into regulated markets. At the time I was looking at the environmental market and what both the Clean Air Act and Clean Water Act did to foster technology adoption. What my research found was that the policies instituted by these Acts led to rapid adoption of technology to meet specific guidelines and subsequently contributed to a cleaner environment. However, these policies also led to a complete stalling of innovation as the policies were too prescriptive. Innovation did not return to these markets until policies had changed allowing market forces to dictate compliance. In the case of the Clean Air Act, it was the creation of a market for trading of COx, SOx and NOx emissions.

We are beginning to see something similar play-out in the HIT market. Stage one got the adoption ball rolling for EHRs. Again, this is a great victory for federal policy and public health. But we are now at a point where federal policy needs to take a back seat to market forces. The market itself will separate the winners from the losers.

His points highlight another reason why I think that ONC should blow up meaningful use. In my plan, I basically see it as the government getting out of the EHR business. I do disagree with John Moore’s comments that the government should step away from interoperability. If they do, we just won’t have interoperability. I guess he’d make the argument that value based reimbursement will force it, but not in the same way that the rest of the EHR incentive money could force the issue.

I have learned that to really get out of this game or even do what I describe will take an act of congress. HHS can’t do this without their help. Although, they could get pretty close. Plus, maybe they could exert their influence to get congress to act, but I won’t be holding my breathe on that one.

May 22, 2014 I Written By

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

NYC Health Systems Get $7M To Share Data

Seven New York City health systems have gotten a delayed Christmas present — a $7 million grant designed to encourage data sharing initiatives and improve patient recruitment for clinical trials. The primary goal of the project is to use evidence-based research to help patients make good decisions about their healthcare.

The funding comes from a group known as the Patient-Centered Outcomes Research Institute, or PCORI. PCORI, which will create a clinical data research network in NYC, has already created 29 such networks across the nation, according to Healthcare IT News.

These networks, collectively, will form PCORnet, a $93.5 million patient-centered research initiative. The New York City Clinical Data Research Network (NYC-CDRN), a  consortium of 22 regional organizations, will work together to develop systems supporting data networking efforts and advance patient-centered research, Healthcare IT News reports.

NYC-CDRN will kick off their efforts by identifying patients with diabetes, obesity and cystic fibrosis. It will then partner with patients and clinicians by creating disease-specific community groups.

The NYC-CDRN network will connect medical records for 6 million New York City residents, then anonymize the records, and over the next 18 months, will work to standardize the data. Ultimately, the goal is to allow patients and providers to have access to evidence-based information they can use to make smart healthcare choices.

This should be an interesting project to watch over the next year and a half. PCORI is doing a lot of forward-thinking work with its money, including $5 million to the NIH for a tool called PROMIS designed to help with comparative effectiveness research. PROMIS has existed since 2004, but PCORI is now helping it move forward, making the $5 million in funds available  in research grants up to $500,000 for projects up to two years in length.

January 29, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Do Hospitals Care About Blue Button?

Jennifer Dennard has been doing a series of blog posts detailing her “Blue Button Patient Journey.” It’s a really insightful look from the patients viewpoint about how Blue Button and patient engagement with their medical records is doing.

My gut reaction when I read that post by Jennifer was that is all felt way too complex with so little value to the patient. Which of course led me to the conclusion that patients aren’t going to do this.

If patients don’t care about Blue Button, is there any reason we should believe that hospitals are going to care about Blue Button? I think we all know the answer to that question.

It would be interesting to go around the hospital and ask people what they thought of Blue Button. I have a feeling hospital employees answers would be more like a Jay Leno “Jaywalking” video than an deep explanation of Blue Button.

Of course, I’m sure that hospitals will be adopting Blue Button more and more. However, most of the people in the hospital won’t know that it’s happening. They’ll just be Blue Button enabled by default when they implement their EHR’s patient portal. Maybe that’s not such a bad thing.

Think about how beautiful it will be to have all of your healthcare data Blue Button enabled. It could open up some really interesting possibilities. In fact, if those in the hospital knew about the data being available through Blue Button they might try and stop it from happening. Freeing healthcare data is a good thing and Blue Button is one step towards freeing the data.

Once those in the hospital realize the health data has been available to patients through blue button all along, then they’ll realize that giving patients their health data won’t cause the universe to implode. Hopefully by then we’ll have some really great applications doing beautiful things with all that blue button data.

January 16, 2014 I Written By

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

Kaiser Permanente Branch Joins Epic Network

Though it apparently held out for a while, Kaiser Permanente Northern California has signed on to Epic Systems’ Care Everywhere, a network which allows Epic users to share various forms of clinical information, Modern Healthcare reports.

Care Everywhere allows participants to get a wide range of patient data, including real-time access to patient and family medical histories, medications, lab tests, physician notes and previous diagnoses. The Care Everywhere network debuted in California in 2008, and has since grown to a national roster of more than 200 Epic users.

Many of the state’s major healthcare players are involved, including Sutter Health, as well as prominent regional players such as Stanford Hospital and Clinics, USCF Medical Center and UC Davis Health System, according to Modern Healthcare. Kaiser Permanente Southern California also participates in the network.

According to Epic, the Care Everywhere system allows patients to take information with them between institutions whether or not both institutions use the Epic platform. Information can come from another Epic system, a non-Epic EMR that complies with industry standards, or directly from the patient.

But of course, the vendor likes to see Epic-to-Epic transmission best, as it notes on the corporate site: “When an Epic system is on both sides of the exchange, a richer data set is exchanged and additional conductivity options such as cross-organization referral management are available.”

Care Everywhere also comes with Lucy, a freestanding PHR not connected to any facility’s EMR system. According to Epic, Lucy follows patients wherever they receive care, and gathers data into a single source that’s readily accessible to clinicians and patients. Patients can enter health data directly into Lucy or upload Continuity of Care Documents from other facilities.

While connecting 200+ healthcare organizations together is a notable accomplishment, Care Everywhere is not going to end up as the default national HIE matter how hard Epic tries. As long as the vendor behind the HIE (Epic) has a strong incentive to favor one form of data exchange over another, it cuts down the likelihood that you’ll have true interoperability between these players. Still, I’ve got to admit it’s a pretty interesting development. Let’s see what healthcare organizations have to say that try to work with Care Everywhere without owning an Epic system.

P.S. It’ll also be interesting to see whether Epic is actually “best” for ACOs, as a KLAS study of a couple of years ago suggested. More recent data suggests that best-of-breed tools will be necessary to build an ACO, even if your organization has taken the massive Epic plunge.

December 26, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Common Misconceptions About HIEs

Health leaders are  interested in connecting up with other organizations — an interest documented by several studies — but many aren’t moving ahead. HIE expansion is proceeding slowly for a number of reasons, not the least of which are concerns about HIE costs and the great difficulty in establishing interoperable data streams.

But some of the reasons healthcare administrators cite for not moving ahead are actually myths, according to a story in Becker’s Hospital Review.  Becker’s spoke with Carol Parker, executive director of the East Lansing, Mich-based Great Lakes Health Information Exchange, who argued that at least three common beliefs about HIEs are myths.

1. HIEs are costly.  According to Parker, hospitals assume that HIE connections will prove to be as expensive as bringing an EMR on board, which naturally gives them pause.  But the truth is that HIE costs are “negligible” compared to EMR expenses, Parker says. For example, she estimates that a 300-bed hospital would pay less than $50,000 per year, a very small number when compared to EMR costs.

2. HIEs are less secure than current systems. Providers worry that HIEs aren’t going to offer strong enough data security to ensure HIPAA compliance. In fact, according to a HIMSS Analytics report, 39 percent of hospitals who are already on board with HIEs have privacy concerns. But according to Parker, HIEs like hers have tight security measures in place.  GLHIE even has a chief privacy and security officer who audits and monitors the data to make sure security meets government and industry standards.

3. HIEs don’t need to be a priority.  According to Parker, providers overwhelmed by EMR installs have “IT fatigue” and don’t feel they can add this one more thing to their efforts. But Parker argues that participation in an HIE is critical, particularly as hospitals take on population health management, and work under performance-based contracts. “It will be challenging to make that work without having information on care delivered to the patient outside of the health system’s network,” she says.

While Parker is obviously biased in favor of HIEs, I believe she makes some good points. It’s particularly interesting to hear that the annual cost of HIE participation, at least with GLHIE, is a relatively small number. Now, just because it’s inexpensive doesn’t mean joining an HIE isn’t a big deal. But it’s good to hear that the costs are probably doable for most hospitals.

October 30, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Ohio HIE Hits 101-Hospital Mark

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.

September 12, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Survey: CIO Pay Isn’t Keeping Up With Responsibilities

With EMRs, ICD-10, HIEs and countless additional technical responsibilities being heaped on the head of healthcare CIOs, one would think that they were paid well for their trouble.  And in most cases, they are.  But a new survey suggests that healthcare CIO pay isn’t keeping up as their responsibilities grow, according to Healthcare IT News.

The survey, by retained executive search firm SSI Search, points out that healthcare reform and the HITECH Act of 2009 have but previously unheard-of pressures on CIOs and IT teams to handle major technology changes and new requirements, “arguably some of the greatest changes to impact modern healthcare in America,” SSI said.

According to SSI Search’, which surveyed 178 respondents,, the typical healthcare CIO these days is a well-educated male who has served in the CIO role for 10 years.  Specifically, 82 percent of respondents were male, 97 percent have a college degree and 61 percent have a master’s degree, Healthcare IT News reports.

Total compensation for these CIOs ranged widely, from less than $125,000 to more than $724,000 per year, Healthcare IT News notes.  But that compensation didn’t track closely with the level of responsibility these CIOs are taking on, the study found. Thirty-eight percent of CIOs reported having an increase in compensation of 10 percent or less over the past four years, SSI concluded.

It’s not that we should feel sorry for these CIOs who, after all, make far more  than most average Americans. But it’s worth noting that their already overloaded plate is having even more piled on it these days.  Whether it’s reflected directly in their compensation or not, CIOs deserve acknowledgement that their very tough job is getting tougher.

For what it’s worth, CIOs seem more or less content with their pay, with more than half reporting that their current compensation is “good – in line with expectations.”

September 5, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Wisconsin Prepares For Statewide HIE

The state of Wisconsin is gearing up to kick off a statewide HIE network that would embrace hospitals, clinics, nursing homes and other care facilities, according to a piece appearing in the Milwaukee Journal Sentinel.

The network, known as the Wisconsin Statewide Health Information Network (WISHIN), is a private nonprofit organization. It expects to add several hospitals to its network this year, and most of the state’s major health systems have committed to participating over time. The health systems and other providers who participate in WISHIN will pay an annual subscription fee based on their size.

WISHIN expects to make a wide variety of information available securely to providers, including problem lists, prescriptions, radiology reports, physician notes and test results, the newspaper notes.

WISHIN will replace the Milwaukee area’s Wisconsin Health Information Exchange, a network which was formed in 2008 and included 13 hospitals in the area. The WHIE was shut down after the region’s health systems decided that being part of a statewide network would be more efficient than relying on a local organization.

WISHIN was created in December 2010, funded by the American Recovery and Reinvestment Act of 2009. Initial planning for the network was done by a body overseen by the state’s Department of Health.

Since then, WISHIN brought in Medicity Inc. to handle the design of the network. Medicity, which is owned by Aetna, is building HIEs in several states.

In kicking off its network, WISHIN is joining a rapidly-growing community of hospitals who have embraced HIEs. In fact, a recent study appearing in the journal Health Affairs concluded that health data exchanges between hospitals and other healthcare providers have climbed 41 percent between 2008 and 2012.

And WISHIN is one of a growing number of statewide efforts. For example, New Jersey’s State Department of Health just awarded $1.57 million to a coalition of HIE group to help them kick off a statewide HIE there.

What’s not clear, from the description of either HIE, is how they’re going to sustain their efforts over the medium and long term;  subscription-model based HIEs have failed in the past and, unless something new is afoot, are likely to fail again.  Let’s see if the ROI is enough to satisfy hospitals and providers this time around.

September 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.