HIE | Hospital EMR and EHR

Survey: Confusion Slowing Meaningful Use Compliance

While Meaningful Use is likely to spur improvements in health IT, confusion over regulations — and the need to pursue other pressing HIT projects — are slowing down MU compliance, according to a new study.

The survey was conducted by Stoltenberg Consulting, which spoke with health IT managers, clinicians, HIT vendors and government agencies that attended this year’s HIMSS event.

Researchers asked which areas in which HIT will achieve the biggest improvements over the next 12 months. The biggest group (35 percent) named Meaningful Use, while 19 percent said health information exchange, clinical integration and mobile health were due for the most growth.

When asked what might hold them back from meeting Meaningful Use requirements, 29 percent said confusion and/or ambiguity in the regulations were a challenge. Others named competing health IT projects (23 percent) and a lack of key resources such as funding, IT skills, talent and time (17 percent).

The survey also asked respondents what issues were likely to dominate HIT discussions this year. Respondents favored health information exchange (62 percent), followed closely by mobile health (58 percent) and clinical analytics (54 percent).

As part of the survey, Stoltenberg also asked survey respondents which problems HIT executives would most likely attempt to solve with the help of a specialized IT consulting firm. The responses included ICD-10 (25 percent), Meaningful Use (25 percent), clinical and business intelligence (23 percent), cloud computing (21 percent) and CPOE/clinical systems implementation (20 percent).

Study: Most Health Organizations Are Implementing HIEs

A study by revenue cycle management vendor Emdeon has concluded that most hospitals and medical practices are getting involved with HIEs, and that a majority of providers were implementing automated medication reconciliation, e-prescribing and EMRs.

To conduct the study, researchers spoke with 147 people from hospitals, large practices and small practices about their HIT practices, according to Becker’s Hospital Review.

Eighty-eight percent of hospitals surveyed had fully implemented or were in the process of implementing health information exchange, Emdeon found. Large practices were even more involved, with 94 percent of those surveyed having fully implemented or begun the process of implementing HIEs. Even smaller practices were largely on board, despite their resource constraints, with 72 percent having fully or partially implemented HIE connectivity.

As for the other health IT initiatives studied, here’s a quick overview of what Emdeon found (stats courtesy of Becker’s):

Hospitals

* 77 percent have implemented or are on the way to implementing automated medication reconciliation
* 85 percent have partially or completely implemented EMRs
* 61 percent have partially or completely rolled out e-prescribing

Large Medical Practices

* 57 percent are implementing or have completed rollout of automated medication reconciliation
* 74 percent have partly or completely implemented EMRs
* 82 percent have partly or fully implemented e-prescribing

Small Medical Practices

* 55 percent have partly or fully implemented automated medication reconciliation
* 62 percent have partly or completely rolled out EMRs
* 62 percent have partly or fully rolled out e-prescribing

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April 23, 2013 I Written By Anne Zieger

Filed Under: Health Information Exchange HIE Hospital EHR Hospital Electronic Health Record Hospital EMR Hospital Healthcare IT Hospital IT Systems

Tags:Becker's Hospital Review Emdeon Health IT Implementatioin HIE Connectivity HIE Stats HIEs Revenue Cycle Management

CommonWell Alliance Goals Challenged By ONC

As virtually everyone in health IT knows, HIMSS saw the dawning of a new EMR vendor alliance which proposes to make health data exchange simpler. The group, the CommonWell Alliance, includes McKesson, Cerner, Allscripts, Greenway and athenahealth, plus McKesson’s connectivity business RelayHealth.

Now that the PR fairy dust has settled and we’re talking serious business, it’s a good time to consider exactly what these vendors hope to accomplish, as we’re talking about enough vendor muscle to have a serious impact on the way health data is shared.

This week, ONC released a report doing just that, according to a piece in Government Health IT. At a meeting of the Health IT Policy Committee on April 3, National Coordinator for Health Information Technology Farzad Mostashari, MD and other committee members discussed the report, which raised some hard questions about the Alliance.

According to Government Health IT, the report outlined the following as CommonWell’s chief goals:

Enabling providers to unambiguously identify patients – but not with a national patient identifier;
Providing a way to match patients with their healthcare records as they transition through care facilities;
Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
Enabling patients to manage consent and authorization;
Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.

Unlike most standards-setting efforts, members of the group are going to have to pay if they want to participate, a nice little detail that wasn’t made clear when CommonWell was announced.

Though it will be at least a year before CommonWell pilots its approach, members of the Committee are quite appropriately wondering now about the impact of such an effort.

Dr. Mostashari argued that the key question is whether the service will work as an optional overlay across a regional exchange, or whether it requires exclusive participation. Other committee members agreed.

The bottom line for committee members, Government Health IT reports, is that they’re willing to take a wait-and-see approach. As for us out here in the peanut gallery, I believe we should challenge the heck out of this thing.

Members of the Health IT Policy Committee are well advised to wonder whether this coming together of powerful HIT vendors could undermine broader efforts to foster interoperability. There’s a lot to look into here, even if the allmighty Epic never joins.

ONC Releases HIE Toolkit For Rural Healthcare

The ONC has released a new toolkit designed to help rural healthcare players such as rural hospitals, critical access hospitals, clinics and state offices of rural health to participate in HIEs, iHealthBeat reports.

Here’s a summary of what the toolkit contains, courtesy of iHealthBeat:

A guide — titled, “Health Information Exchange-First Considerations” — which covers the first steps in establishing or joining a health data exchange
A spreadsheet — called the “ROI Calculator” — which helps determine possible costs and savings associated with implementing electronic health record systems and health information exchanges
A guide — titled, “HIE Direct Guide” — which aims to help health care providers understand and implement data exchange using protocols from the federally developed Direct Project
A tool — titled, “HIE Policy Matrix” — which includes policy recommendations adapted from the Connecting for Health Common Framework
A guide — titled, “Privacy and Security Overview and Resource List” — which details privacy and security requirements for data exchanges

The toolkit release follows on ONC head Farzad Mostashari’s announcement that this will be the year providers are pushed hard to go for interoperability.

Expect to see more efforts of this kind as ONC nobly soldiers along, suffering from a trimmed budget due to sequestration, attempting to close the gaps vendors seem loathe to close.

Yes, as Mostashari notes in an interview with HealthcareITNews, Meaningful Use Stage 2 pushes the vendors a long way toward interoperability:

Vendors are really going to have to step up to the plate in terms of being able to achieve the Stage 2 expectations for true vendor-to-vendor coded, clinical structured, documents being able to have kind of ubiquitous protocols with security in place. That’s a big step for the industry and meaningful use Stage 2 sets the tempo and expectations for that.

But vendors have proved amazingly agile at wiggling out of interoperability promises to date. Let’s see if MU Stage 2 finally breaks the deadlock.

NY RHIO Brings EMRs To Ambulances

Even with a well-connected RHIO in place, and a healthy EMR on site, most hospitals have to content with paper records when ambulances pull up to their door. But in Rochester, they’ve changed things up.

The Rochester Regional RHIO has partnered with area EMS agencies to put technology in place allowing EMS workers to securely share data with EDs or primary care doctors, reports the Rochester Democrat and Chronicle.

The RHIO itself seems to be a hit — 850,000 people, or half of the Rochester-area population, have agreed to have their records shared with authorized medical providers, the paper notes. It embraces 40 healthcare organizations in the 13-county greater Rochester area, providing links to hospitals, reference labs, radiology practices, eldercare agencies and health plans along with the ambulance teams.

To communicate patient information, the EMS workers create an “electronic pre-hospital care document” which can be uploaded to the patient’s medical record (even if the patient declines to go to the hospital). The ePCD technology is available to EMS crews for no cost.

While there’s scattered use of this approach, mobile EMR connections for EMS workers are unusual, as far as I can tell. But with mobile healthcare apps and EMR front ends growing more sophisticated every day, the time is coming soon when anyone who touches the healthcare process in any way, including EMS personnel, will have a wirelessly-enabled tablet loaded with the software they need to report on the patient.

Frankly, I’m surprised all EMS techs don’t have such a tool already. It just makes too much sense.

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February 20, 2013 I Written By Anne Zieger

Filed Under: Health Information Exchange HIE Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT iPad/iPhone Mobile Technology

Tags:Ambulance Democrat and Chronicle Emergency EMR Mobile EMR Rochester Regional RHIO

We Have an HIE – The Internet

Jon Fox, MD and Founder of HealthApp Connect sent me a great message:

We already have a great free HIE and it’s called the internet

He makes an interesting point. Reinforces why I called for hospital CIO’s to start making interoperability a reality as opposed to just talking about it. The technology and connectivity is there. Every hospital is connected to the internet and therefore already connected to every hospital out there. That simplifies the issues, but enough people are overcomplicating what needs to happen. Maybe we need some more people in healthcare willing to look at interoperability more simply.

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February 11, 2013 I Written By John

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

Filed Under: Healthcare CIO HIE Hospital CIO Hospital Healthcare IT

Tags:HealthApp Connect Healthcare Interoperability Jon Fox

Hospital Consolidation

There are a number of trends happening in healthcare right now that are hard to ignore. Plus, they are going to absolutely change the dynamics of healthcare as we know it. I think one of the biggest trends we’re seeing is the healthcare consolidation.

Healthcare consolidation is happening as hospitals come together and as hospitals buy up physician practices. I’ve heard some people argue that soon we’ll only have about 15 companies that own all the hospitals in the US. That seems pretty aggressive, but I think consolidation will likely amount to that many major ones with some minor ones in areas where the major corporations don’t really care.

In a lot of ways, consolidation of hospitals can be a great thing. Consolidation can often mean a lot of cost savings for the hospitals since you can merge departments and gain savings. Plus, your buying power is larger and so you can get the same goods at a lower cost. As we continue to move towards the ACO world consolidation can be a good thing as well since you need everyone involved to make an ACO a success. What better way to get them involved than to have them all in one company?

Also, if all the hospitals are under one company, then it makes for easy exchange of healthcare data between hospitals. Oh wait, for some reason healthcare still hasn’t figured this one out (Yep, we can’t even share healthcare data within a private HIE very well). Maybe this will change.

While there can be many benefits to hospital consolidation, there can also be a number of huge challenges. What if a doctor works for a hospital and they hate the EHR (or insert other reason as you see fit) that the hospital uses? If the hospital system owns all the hospitals in that area, then the doctor doesn’t have much choice. Same goes for a patient who wishes the hospital provided more advanced services. They’ll try to go to the hospital across town and find that it’s the same company and the same processes.

At that point, what incentive does the hospital system have to really truly improve? Sounds like a monopoly waiting to happen to me.

I asked someone how we stop the hospital consolidation. He said, “We don’t.” It’s a fast moving shift that can’t really be stopped. So, we just need to learn to adapt to the new environment.

It will be interesting to see how the EHR world plays out with hospital consolidation. Is a hospital system going to force a certain EHR on their acquired hospitals so they have one EHR to serve all? I bet the answer is they’re likely going to have a number of EHR software in every hospital system. This is going to require a change in mentality for many.

Hospital-Backed HIE On The Rocks

In an all-too-familiar tale of conflict, turf wars and financial doubts, a three-year effort to bring some of the Chicago area’s largest hospitals into an HIE seems on the verge of collapse.

The proposed HIE is backed by the Metropolitan Chicago Healthcare Council, a nonprofit group of about 150 hospitals and healthcare providers. But despite industry backing, the effort hasn’t gotten any momentum. Though the Council has been flogging the HIE concept since 2009, just 18 hospitals and physician groups have agreed to join, according to a report in Crain’s Chicago Business.

In theory, the massive, sophisticated health systems that serve the Chicagoland area would see the value in sharing medical records if anyone would. If nothing else, they’re doubtless thinking about or already participating in risk-bearing ACO contracts, so cutting down on needless duplicated tests would be a plus.

But apparently, potential HIE members are balking at the cost of sustaining the HIE, which can run to six figures annually depending on the institution. Apparently, they’re not sure that they’ll get a decent return on their investment. And of course, there’s little doubt that these systems are already investing many, many millions in EMRs and supporting systems, tying up most if not all of their IT investment budget.

What’s more, while Crain’s doesn’t mention this issue, I’d argue that hospitals are also skittish about cooperating with their competitors. Particularly in an intensely competitive market like Chicago, hospitals and health systems may feel that HIEs are a step too close to the enemy.

Now, even if the major hospitals refuse to invest in the HIE, the Council does have other ways that it might be able to pay for the exchange. For one thing, the group has begun discussions with health insurers to see if they might be interested in helping to fund it. And there’s always government grants, which are available to help kick off startup HIEs.

The bottom line, though, is that hospitals are still conflicted when it comes to HIE involvement. Though most CIOs say that they’re interested in being involved, financial — and let’s not forget competitive — issues prevent them from getting on board.

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January 2, 2013 I Written By Anne Zieger

Filed Under: HIE Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems IDN

Tags:ACO ACO Contracts Chicago Hospitals Health Information Exchange Hospital HIE Metropolitan Chicago Healthcare Council

Do Epic Customers Have EMR Stockholm Syndrome?

John’s Note: I guess Anne didn’t see my post about the EMR Stockholm Syndrome. I think she adds to the discussion with this post though.

According to a recent piece appearing in KevinMD.com, by next year an astonishing 40 percent the U.S. population will have their medical data stored in an Epic system. Heaven only knows how many billions of dollars of IT capital outlay that represents. What we can safely guess is that not a single customer making up that list failed to make painful sacrifices to bring Epic on board.

Having spent so much and worked so hard to get Epic up and running, you’d expect to hear at least some complaints from hospital C-suites about the ordeal of it all. And despite its popularity, you’d expect far more hospitals to blanch at the, uh, epic price tag on an Epic install and say “no thanks.” But instead, you see hospital leader after hospital leader speaking glowingly about Epic and choosing it over competitors time and time again.

As author Paul Levy notes (himself the former CEO of Beth Israel Deaconess Medical Center), Epic isn’t just expensive. It’s also something of a pain to work with:

* Epic has made a policy of not being interoperable with other EMRs, scuttling HIE plans that have become increasingly important to hospital business plans

* Epic decides when system upgrades are needed and changes to the EMR are needed

What Paul doesn’t mention, but is worth considering as well, is that Epic only gets installed if you work with teams of its relatively green staff members, hotshot types in their twenties who may be very smart are definitely on the arrogant side if reports I’ve heard are true.

So, if hospitals are still singing Epic’s praises after all of this stress and expense and letting a vendor dictate important aspects of its development roadmap, is the industry suffering from Stockholm Syndrome (a feeling of bonding with people who have captured you)? As Levy sees it, the answer seems to be yes. What do you think?

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: Most Health Organizations Are Implementing HIEs

CommonWell Alliance Goals Challenged By ONC

ONC Releases HIE Toolkit For Rural Healthcare

NY RHIO Brings EMRs To Ambulances

We Have an HIE – The Internet

Hospital Consolidation

Hospital-Backed HIE On The Rocks

Do Epic Customers Have EMR Stockholm Syndrome?

EMR Issues To Address In 2013

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