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Survey Data on the Healthcare IT Job Market

Posted on March 24, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 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 and LinkedIn.

I’ve been working for a number of years with Pivot Point Consulting, a Vaco Company (previously known as Greythorn) on their Health IT Market Report that looks at the Healthcare IT career space. This year they decided to do a trends edition that took this year’s survey results and compared it with historical data from the past three years which added a new layer of insight to the report.

While at the HIMSS conference, I had a chance to sit down with Ben Weber, Managing Partner, Pivot Point Consulting, a Vaco Company, to talk about their Health IT Market Report and the insights that were gleaned from their survey.

You can find my full video interview with Ben Weber at the bottom of this post or click on any of the links below to skip to a specific topic we discussed:

Be sure to download the full 2017 Healthcare IT Market Report: Trends Edition to dive into the responses to all the questions on the survey. Let us know in the comments what survey results stand out to you.

If you’re searching for a healthcare IT job, be sure to check out the jobs that Pivot Point Consulting has posted on Healthcare IT Central.

Who’s Over MACRA? CIO? COO?

Posted on March 22, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 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 and LinkedIn.

In no surprising way, MACRA is a major topic in pretty much every hospital and health system in the US. There’s a lot of money to be had or lost with MACRA. This is especially true for health systems with a lot of providers. Plus, it sets the foundation for the future as well. I believe MACRA will be as impactful as meaningful use, but without as many incentive payments (chew on that idea for a minute).

As I’ve talked to hundreds of organizations about MACRA, I’ve seen a whole array of responses for how they’re addressing MACRA and who is in charge. Is this a CIO responsibility since MACRA certainly requires EHR and other technology? Is this a COO job because MACRA is more of an operations problem than it is a technical problem? Some might make the case for the CMO/CMIO to be in charge since MACRA requires so much involvement from your providers.

From my experience, the decision usually comes down to choosing between the CIO and the COO, but with input and buy-in from the CMO/CMIO. How the CIO positions themselves will determine if they are over MACRA or not. Some CIOs see themselves as tech people and so they shy away from touching MACRA. Other CIOs see themselves as integral part of their business success and so they want to have MACRA under their purview. Most progressive CIOs that I talk to want the later.

I’m an advocate for a CIO that’s involved in the business side of things. Those CIOs that don’t want this duty are going to miss out on strategic opportunities for their organization. I heard one CIO describe that they viewed their IT organization as Information As A Service provider. Their job as the IT department was just to provide the information from the IT systems to someone else who would deal with the information, the MACRA regulations, etc.

The Information as a Service provider concept has issues on multiple levels. The most important is that if you’re just an information provider, then you lose out on the opportunity to be a strategic part of your organization. However, from a more practical MACRA level, it’s really challenging to provide the right information for MACRA when you’re just an information provider and know little about the regulation. We all know how quickly communication can break down when the person needing the information is disconnected from the people who provide the information and they’re disconnected from the people entering the information.

No doubt a healthcare CIO has to be careful what projects they add to their plate. However, I don’t think MACRA is one of those projects that should be pushed off to someone else. Certainly there can be specific organization cultures where it makes sense for the COO to run things, but I think that should be pretty rare.

How are you approaching MACRA at your organization? Who’s over it? I look forward to hearing your experiences in the comments.

The Challenge of Managing So Many Vendors

Posted on March 8, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 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 and LinkedIn.

The more I talk to CIOs, the more I realize that CIO at a hospital and health system is as much about vendor management as it is anything else. And quite frankly, those CIOs are tired and overwhelmed by all the vendor management they do. Every CIO I’ve met is looking to decrease the number of vendors they’re working with and not increase it.

In some ways it makes sense. Even if you look at the basic IT commodity items like servers, systems, storage, networking, security, single sign on, etc you’re probably looking at 14-16 vendors for most organizations. This doesn’t include all the higher end clinical systems (including the EHR) and all of the shadow IT systems that have seeped their way into departments thanks to easy to purchase and use cloud solutions.

At the higher end, I’ve heard of some health systems having 300 different systems that they had to manage. It’s a much smaller number at the lower end small, rural hospital, but it’s still a huge task for even them since they outsource almost everything. They usually can’t attract or afford long term staff to the rural hospitals.

Is it any wonder why that hospital CIO told me that “we’ve got what we need”?

I wonder if the real undercurrent of his comment was “I don’t want any more vendors to manage. I have more than enough!”

My guess is that this CIO who has “all the IT he needs” would probably have no problem looking at and implementing new features and functionality from their existing vendor. That’s a huge advantage for existing vendors as they continue to grow a bigger footprint in the hospitals where they have customers. However, are they missing out on a lot of innovations because of this approach?

At the end of the day, a CIO has to be an effective vendor manager. The better they do at this job, the better their organization will perform.

EMR Add-Ons On The Way

Posted on March 3, 2017 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.

A new study backed by speech recognition software vendor Nuance Communications has concluded that many healthcare leaders are planning to add new technologies to supplement their EMRs, Popular add-ons cited by the study include (naturally) speech recognition, mobility options and computer-assisted physician documentation tools. While the results are partially a pitch for Nuance, of course, they also highlight the tension between spending on clinical improvement and satisfaction and boosting the bottom line with better documentation tech.

The study, which was conducted by HIMSS Analytics, was designed to look at ways to optimize EMRs and opportunities to improve care at hospitals and health systems. Conducted between August 17 and September 6 of last year, it draws on 167 respondents from 142 different healthcare organizations. Forty percent of respondents hold C-suite titles, and an additional 40% were in IT leadership. (It would be interesting to see how the two groups’ perceptions vary, but the study summary doesn’t provide that information.)

According to HIMSS, 83% of respondents reported having confidence that their organization would eventually realize their full potential, particularly improving care coordination and outcomes.

To this end, 75% of respondents said they’d boosted their EMR efforts with training and support resources, while two-thirds have increased staff in at least one IT area since implementing their system. Respondents apparently didn’t say how much they’d increased their budget, if at all, to meet these needs – and you have to wonder how these organizations are paying for these efforts, and how much. But the report didn’t provide such information.

To increase clinician satisfaction with EMR use, 82% of respondents said providing clinician training and education, 75% are enhancing existing technology and tools and 68% adopting new technology and tools. To read between the lines once again, it’s worth noting that hospitals and health systems seem to be putting a stronger emphasis on training than new tech, which somewhat contradicts the study’s conclusions. Still, EMR add-ons clearly matter.

Meanwhile, about one-quarter of survey respondents said that they planned to introduce EMR-enhancing tools at the point of care, primarily to improve documentation and boost physician satisfaction. Those included mobility tools (44%), computer-assisted physician documentation (38%) and speech recognition (25%). These numbers seem a bit lower than I would have expected, particularly the mobile stat. I’m betting that establishing mobile security is still a tough nut to crack for most.

While increasing clinician satisfaction and improving care outcomes is important, boosting financial performance clearly matters too, and respondents said that improving documentation was central to doing so. Fifty-four percent said that better documentation would reduce the number of denied claims they face, 52% expect to improve performance under bundled payments, 38% predicted reduced readmissions and 38% thought documentation improvements would better physician time management and improve patient flow.

Again, I doubt that C-suite execs and IT leaders will pay equal attention to tools which improve their finances and those which meet “softer” goals – and financial goals have to take priority. But these stats do suggest that hospitals and health systems are giving EMR add-ons some attention. It will be interesting to see if they’re willing to invest in EMR enhancements — rather than burrowing deeper into their existing EMR tech — over the next year or two.

Cleveland Clinic Works To Eliminate Tech Redundancies

Posted on March 1, 2017 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 Cleveland Clinic has relied on its EMR for quite some time. In fact, it adopted Epic in the 1990s, long before most healthcare organizations were ready to make a bet on EMRs. Today, decades later, the Epic EMR is the “central data hub” for the medical center and is central to both its clinical and operational efforts, according to William Morris, MD, the Clinic’s associate chief information officer.

But Morris, who spoke about the Clinic’s health IT with Health Data Management, also knows its limitations. In an interview with the magazine’s Greg Slabodkin, he notes that while the EMR may be necessary, it isn’t sufficient. The Epic EMR is “just a digital repository,” he told Slabodkin. “Ultimately, it’s what you do with the technology in your ecosystem.”

These days, IT leaders at the Clinic are working to streamline the layers of additional technology which have accreted on top of the EMR over the years. “As an early adopter of Epic, we have accumulated quite a bit of what I’ll call technical debt,” said Doug Smith, interim chief information officer. “What I mean by that is multiple enhancements, bolt-ons, or revisions to the core application. We have to unburden ourselves of that.”

It’s not that Clinic leaders are unhappy with their EMR. In fact, they’re finding ways to tap its power to improve care. For example, to better leverage its EMR data, the Cleveland Clinic has developed data-driven “risk scores” designed to let doctors know if patients need intervention. The models, developed by the Clinic’s Quantitative Health Sciences group, offer outcome risk calculators for several conditions, including cancer, cardiovascular disease and diabetes.

(By the way, if predictive analytics interest you, you might want to check out our coverage of such efforts at New York’s Mount Sinai Hospital, which is developing a platform to predict which patients might develop congestive heart failure and care for patients already diagnosed with the condition more effectively. I’ve also taken a look at a related product being developed by Google’s DeepMind, an app named Streams which will ping clinicians if a patient needs extra attention.)

Ultimately, though, the organization hopes to simplify its larger health IT infrastructure substantially, to the point where 85% of the HIT functionality comes from the core Epic system. This includes keeping a wary eye on Epic upgrades, and implementing new features selectively. “When you take an upgrade in Epic, they are always turning on more features and functions,” Smith notes. “Most are optional.”

Not only will such improvements streamline IT operations, they will make clinicians more efficient, Smith says. “They are adopting standard workflows that also exist in many other organizations—and, we’re more efficient in supporting it because we don’t take as long to validate or support an upgrade.”

As an aside, I’m interested to read that Epic is tossing more features at Cleveland Clinic than it cares to adopt. I wonder if those are what engineers think customers want, or what they’re demanding today?

Many Providers Still Struggle With Basic Data Sharing

Posted on February 15, 2017 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.

One might assume that by this point, virtually every provider with a shred of IT in place is doing some form of patient data exchange. After all, many studies tout the number of healthcare data send and receive transactions a given vendor network or HIE has seen, and it sure sounds like a lot. But if a new survey is any indication, such assumptions are wrong.

According a study by Black Book Research, which surveyed 3,391 current hospital EMR users, 41% of responding medical record administrators find it hard to exchange patient health records with other providers, especially if the physicians involved aren’t on their EMR platform. Worse, 25% said they still can’t use any patient information that comes in from outside sources.

The problem isn’t a lack of interest in data sharing. In fact, Black Book found that 81% of network physicians hoped that their key health system partners’ EMR would provide interoperability among the providers in the system. Moreover, the respondents say they’re looking forward to working on initiatives that depend on shared patient data, such as value-based payment, population health and precision medicine.

The problem, as we all know, is that most hospitals are at an impasse and can’t find ways to make interoperability happen. According to the survey, 70% of hospitals that responded weren’t using information outside of their EMR.  Respondents told Black Book that they aren’t connecting clinicians because external provider data won’t integrate with their EMR’s workflow.

Even if the data flows are connected, that may not be enough. Researchers found that 22% of surveyed medical record administrators felt that transferred patient information wasn’t presented in a useful format. Meanwhile, 21% of hospital-based physicians contended that shared data couldn’t be trusted as accurate when it was transmitted between different systems.

Meanwhile, the survey found, technology issues may be a key breaking point for independent physicians, many of whom fear that they can’t make it on their own anymore.  Black Book found that 63% of independent docs are now mulling a merger with a big healthcare delivery system to both boost their tech capabilities and improve their revenue cycle results. Once they have the funds from an acquisition, they’re cleaning house; the survey found that EMR replacement activities climbed 52% in 2017 for acquired physician practices.

Time for a comment here. I wish I agreed with medical practice leaders that being acquired by a major health system would solve all of their technical problems. But I don’t, really. While being acquired may give them an early leg up, allowing them to dump their arguably flawed EMR, I’d wager that they won’t have the attention of senior IT people for long.

My sense is that hospital and health system leaders are focused externally rather than internally. Most of the big threats and opportunities – like ACO integration – are coming at leaders from the outside.

True, if a practice is a valuable ally, but independent of the health system, CIOs and VPs may spend lots of time and money to link arms with them technically. But once they get in house, it’s more of a “get in line” situation from what I’ve seen.  Readers, what is your experience?

Boston Children’s Benefits From the Carequality and CommonWell Agreement

Posted on February 3, 2017 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.

Recently two of the bigger players working on health data interoperability – Carequality and the CommonWell Health Alliance – agreed to share data with each other. The two, which were fierce competitors, agreed that CommonWell would share data with any Carequality participant, and that Carequality users would be able to use the CommonWell record locator service.

That is all well and good, but at first I wasn’t sure if it would pan out. Being the cranky skeptic that I am, I assumed it would take quite a while for the two to get their act together, and that we’d hear little more of their agreement for a year or two.

But apparently, I was wrong. In fact, a story by Scott Mace of HealthLeaders suggests that Boston Children’s Hospital and its physicians are likely to benefit right away. According to the story, the hospital and its affiliated Pediatric Physicians Organization at Children’s Hospital (PPOC) will be able to swap data nicely despite their using different EMRs.

According to Mace, Boston Children’s runs a Cerner EMR, as well as an Epic installation to manage its revenue cycle. Meanwhile, PPOC is going live with Epic across its 80 practices and 400 providers. On the surface, the mix doesn’t sound too promising.

To add even more challenges to the mix, Boston Children’s also expects an exponential jump in the number of patients it will be caring for via its Medicaid ACO, the article notes.

Without some form of data sharing compatibility, the hospital and practice would have faced huge challenges, but now it has an option. Boston Children’s is joining CommonWell, and PPOC is joining Carequality, solving a problem the two have struggled with for a long time, Mace writes.

Previously, the story notes, the hospital tried unsuccessfully to work with a local HIE, the Mass Health Information HIway. According to hospital CIO Dan Nigrin, MD, who spoke with Mace, providers using Mass Health were usually asked to push patient data to their peers via Direct protocol, rather than pull data from other providers when they needed it.

Under the new regime, however, providers will have much more extensive access to data. Also, the two entities will face fewer data-sharing hassles, such as establishing point-to-point or bilateral exchange agreements with other providers, PPOC CIO Nael Hafez told HealthLeaders.

Even this step upwards does not perfect interoperability make. According to Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, providers leveraging the CommonWell/Carequality data will probably customize their experience. He contends that even those who are big fans of the joint network may add, for example, additional record locator services such as one provided by Surescripts. But it does seem that Boston Children’s and PPOC are, well, pretty psyched to get started with data sharing as is.

Now, back to me as Queen Grump again. I have to admit that Mace paints a pretty attractive picture here, and I wish Boston Children’s and PPOC much success. But my guess is that there will still be plenty of difficult issues to work out before they have even the basic interoperability they’re after. Regardless, some hope of data sharing is better than none at all. Let’s just hope this new data sharing agreement between CommonWell and Carequality lives up to its billing.

McKesson and Infor Go-To-Market Partnership – What Happens Now?

Posted on January 9, 2017 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

A couple weeks ago, McKesson and Infor announced a partnership that will have McKesson EIS (Enterprise Information Solutions) offering Infor Cloudsuite as their cloud-based ERP (Enterprise Resource Planning) solution for human resources, supply chain, and financials. What does each party have to gain from this partnership and what does this mean for existing customers of McKesson ERP solutions?

Infor continues to be the dominant player in the ERP space for healthcare providers. Its healthcare applications, previously known as Lawson (and probably always known as Lawson to many of us), have the largest market share with the majority of larger hospitals and healthcare systems. Its closest competitor in the past, Peoplesoft, is now owned by Oracle which is focused on developing and promoting its Fusion product and has released the final version of the Peoplesoft product. Workday, the cloud-only solution that is publicly traded and making significant strives in many industries, has won deals in human resources and financials implementations but lacks a supply chain solution, critical to any integrated ERP deployment. SAP, the largest ERP provider in the world, has a strong presence in healthcare manufacturers but does not provide a supply chain solution well suited for the unique needs of healthcare providers, and therefore has a very small market share.

McKesson, once a strong player in this space, has faded over the years in ERP as they have with EHR solutions. The majority of the McKesson ERP customer base, using the products commonly referred to as Pathways, have been long-time legacy customers. Pathways has not been kept up with modern ERP needs, and it has been many years since I have seen a hospital consider Pathways as a potential solution, but rather it is typically the solution being replaced.

Infor has invested significantly in creating a cloud-based solution, referred to as CloudSuite. However, the existing healthcare customer base typically has an on-premise installation and therefore cloud adoption has been focused on new customers as well as those that are specifically looking to transition away from on-premise. McKesson has not had a cloud offering, therefore it would make sense for them to partner with someone to offer it as an alternative to Pathways.

Infor will gain access to the Mckesson customer base, many of whom are likely considering leaving Pathways for other solutions anyway. In addition, Infor will be able to provide Mckesson’s Strategic Sourcing solution for their customers.

However, it is unclear what that means for Pathways. While McKesson press releases state that CloudSuite is an alternative to Pathways, one has to wonder why Infor would want to expose their solution to someone who is actively selling a competitive solution, and why McKesson would continue to invest in Pathways when it has access to a much more mature and robust solution as a go-forward path for its Pathways customers.

Therefore while it is likely that McKesson will keep Pathways supported and up-to-date with regulatory improvements for the time being, it seems very unlikely that they would continue to enhance it – and inevitable that it will eventually be sunset in favor of transitioning those customers to Infor Cloudsuite. If history is indeed an appropriate predictor of the future, consider that McKesson announced its BetterHealth 2020 plan – in which they announced a focus on Paragon as their EHR but continued support of the older Horizon EHR product. Shortly after that they went back on that commitment and announced they would sunset Horizon in 2018.

Meaningful Use has led to a focus of resources on Electronic Health Records implementations which have led many customers to hold onto their older ERP solutions past their useful life. I suspect that the next two years will see a re-focus to ERP solutions with customers with more modern solutions focusing on upgrades and new feature deployment while customers with older solutions making a change.

Those customers who stayed on Horizon for too long are currently in a rush to implement replacements before the March 2018 sunset date.Customers on Pathways products should likely start the conversation now about their long-term ERP plans and consider if they want to get ahead of any sunset announcement.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Indecision in Upgrading Infrastructure – Blamed on Meaningful Use

Posted on January 6, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 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 and LinkedIn.

In a conversation I had with Steve Prather, CEO at Dizzion, he made a really interesting observation about meaningful use causing delays in upgrading infrastructure at many healthcare organizations. It’s not hard to see how spending millions, hundreds of millions or even billions of dollars on EHR and related services in order to meet the meaningful use requirements could cause budget cuts in other areas like upgrading infrastructure.

Of course, the opposite can be true as well. I know when we first implemented an EHR, a good portion of the EHR budget was to upgrade some of the infrastructure needed to support the new software. I’m sure that probably means that some infrastructure benefited from the EHR upgrade and meaningful use, but I’m sure some infrastructure spending also got cut or delayed.

In my conversation with Steve he went on to observe that much of the hardware in healthcare organizations had gotten so old, indecision and delays were no longer a choice. Having talked to many CIOs, they feel this in their organizations. While many CIOs want to move on to more strategic efforts, there’s still a big part of any CIOs job that requires them to maintain and upgrade their IT infrastructure. Although, it seems that many of them are looking to push this responsibility off to a kind of IT COO position.

I’ll be interested to watch and see how these organizations approach their infrastructure upgrades. Will most continue to do all the work in house or will they start to outsource this essentially commodity task to an outside company? There’s a really interesting case for why organizations should outsource this work as opposed to continuing to do it in house. All of this points back to the CIO becoming a vendor management organization.

Has your infrastructure upgrades been delayed by meaningful use? Is your organization looking to finally upgrade or is MACRA going to delay things further?