Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Susannah Fox Named As First Woman CTO of HHS

Posted on May 29, 2015 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 case you’ve been busy like me, this week Susannah Fox was named as the new CTO of HHS. She’s the first woman to be appointed to this position and is following in the footsteps of Todd Park (who later became the US CTO) and Bryan Sivak.

The HHS CTO position was started in 2009 and so it’s a relatively new position, but I think it’s exciting that HHS would choose Susannah Fox for this position. Fox has worked as the associate director of the Pew Research Center and as the entrepreneur in residence at the Robert Wood Johnson Foundation.

Those of us on social media know @SusannahFox very well since she was very active on Twitter and often joined in on various healthcare IT discussions that were happening online. Plus, Susannah Fox was a regular speaker at healthcare IT events.

What I love most about the prospect of Susannah Fox being involved at HHS is that she’s a total health data geek. I say that with the utmost respect and admiration. In fact, I don’t throw compliments like that out easily. She’s a true data geek that’s been diving into healthcare data for a long time. I think that’s going to be a very valuable quality in her new role at HHS.

Maybe I’m wrong, but I think that one of HHS’ major roles should be around using data to improve healthcare in the US. I think that’s the potential opportunity for them and one that they haven’t done a great job leveraging to date. I’m hopeful that Susannah Fox will be able to help in that regard.

Think about all the powerful women at the head of HHS: Sylvia Burwell, Karen DeSalvo, and now Susannah Fox (and I’m sure there are many more that I don’t know as well). I think that’s a great thing. I look forward to the future they’re paving. They don’t have an easy job ahead, but I do think they have tremendous opportunity.

Is Epic Too Big To Fail?

Posted on May 27, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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.

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

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

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

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

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

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

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

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

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

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

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

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

The Hospital With No EMR

Posted on May 20, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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 weekend, feeling a bit too ill to wait to see my PCP, I took myself to a community hospital in my neighborhood. For various reasons, I went to a hospital I don’t usually visit, one about 10 miles away from my home.

When I entered the emergency department lobby, nothing seemed amiss.

In fact, the light-filled, pleasantly-constructed waiting room was comfortable and modern, the staff seemed bright and knowledegeable, and the triage nurse saw me promptly.

But I got something of a surprise when I checked in with the triage nurse during my initial assessment. Noting that she had not taken my medication history, I told the nurse that I assumed someone would be entering it into their EMR later.

“We don’t have an EMR,” said the kind and sympathetic triage nurse apologetically. “Everything is still on paper. We might have an EMR in a year or so, but we’re not even sure about that.”

As it later turned out, she was mistaken. The hospital did indeed have an EMR in place, one by MEDITECH, but had put all new upgrades on hold, leaving the clinical staff to do almost all documentation on paper.  Regardless, the staff didn’t have access to the higher capabilities of an EMR, and that’s the message that the triage nurse had gotten. (And no one ever did take my list of medications.)

Now, it’s not necessarily the case that this hospital had no grasp of its data. In fact, to my surprise, the front desk was able to tell me that I had been seen there in 2002, something of which I had no memory.

But it’s hard to imagine that the very long wait I endured, which took place in the attractive lobby of a quiet, prosperous suburban hospital, was not due in part to the hospital’s lack of automation. It should be noted that within the next several months to a year, the chain to which the hospital belonged expects to bring the hospital I visited onto its Epic platform. But again, the staff was stumbling around in the dark, comparatively speaking, the day I visited the ED.

Now, hospitals survived on paper documentation for many years, and there’s no reason to think this one won’t survive for a year or so using paper charts. What’s more, it may very well be that the real problem this hospital faced had to do with patient mix and staffing concerns. I did note that many of the patients coming in seemed to be seeking weekend primary care, for which the hospital may not have been as prepared as it should have been.

That being said, an EMR is not just a clinical tool. Put coldly, it’s an instrument of industrial automation which can keep patients moving through the assessment and discharge process more quickly and effectively.

I’m not saying the facility needs to have a fully-launched marquee EMR just to impress patients like myself. In fact, postponing expanding the Epic EMR for a while may be a great financial decision, and from an IT standpoint, better to roll the Epic system out at a sustainable pace than throw it at an unprepared workforce.

But watching nurses and doctors record details on endless sheets of paper, and struggle to track down paper charts for acutely ill patients, was a harsh reminder of what the industry has left behind.

What If Doctors Owned Part of Hospital EMRs?

Posted on May 19, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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.

After this many years of widespread use, you’d think that physicians would have accepted that EMRs are an inevitable part of practicing medicine — and at least sometimes, a useful tool that helps doctors manage their panel of patients more effectively.  But it seems some hospital administrators have concluded that a significant percentage of doctors loathe EMRs.

I draw this conclusion not from casual conversation with physicians, but from a hospital recruiting advertisement quoted in The New York Times.  The advertisement, which was attempting to attract doctors to a facility in Phoenix, closed its glowing description of state-of-the-art equipment and an attractive location with a single provocative line, all in bold: “No E.M.R.s.”

While EMRs are getting long in the tooth these days, they haven’t won over many doctors. As physician Robert Wachter notes in his NYT piece on the subject, a 2013 RAND survey found physicians most unhappy with EMRs, citing “poor usability, time-consuming data entry, needless alerts and poor work flows.”

I think it’s pretty obvious why EMRs continue to stay user-hostile. While doctors are the end users of  EMRs, hospital IT leaders and other CXOs make the final buying decisions. And he (or she) who writes the check makes the rules.

In theory, it’s strongly in hospital management’s interests to force EMR vendors to clean up their usability act.  After all, not only do hospital leaders want their EMRs used effectively, they want the data to be robust enough to be usable for value-based care delivery. But the truth is that hospital leaders are nowhere near demanding enough of EMR vendors. And because they’re the ones writing the checks, doctors get stuck with the ugly results.

But what if there was a way to involve both doctors and hospitals financially, as partners, in buying EMRs?  Not being the world’s greatest finance wizard, I don’t know how a hospital and a group of physicians could structure a deal that would allow them to jointly own the hospital’s EMR system. And I’m aware, though I don’t know how they would be addressed, that there could be significant legal issues to be resolved if the hospital was a not-for-profit entity.

But at least in theory, if doctors were paying for a percentage of the EMR, they’d have a lot more say as to what level of usability they’d demand, what features were most important to them, and what price they’d be willing to pay for the system. In other words, if doctors had skin in the game, it would put a great deal of pressure on vendors to make EMRs doctors actually liked.

Now, I realize that doctors might have no interest in buying into a technology which has let them down again and again. But there’s a chance that more visionary and tech-friendly physicians might grab the chance to have a substantial say in the EMR-buying process. The idea is worth a look.

ICD-10 Poll

Posted on May 6, 2015 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 recently saw an ICD-10 survey that looked at ambulatory preparedness for ICD-10. That survey highlighted a number of ICD-10 business areas of concern that are worth considering in hospitals as well:

  • Training/Education
  • Payer Tersting
  • Software Upgrade Cost
  • Claims Processing
  • Compliance Timeline/Deadline

If your hospital hasn’t considered these areas of ICD-10 readiness, then you might want to start doing so now.

Of course, I’m interested to know what people think about ICD-10. Will it get delayed again? Will it finally go forward? Let’s hear what you think in the poll below.

My personal feeling is that if I’m running a hospital, I’m going to have to act like ICD-10 is going forward and plan accordingly. I don’t want to be caught unprepared because I was holding out hope that it would be delayed again. What do you think? Is that wise advice for hospitals?

Do Hospital #HIT Leaders Need Business Coaches?

Posted on May 4, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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.

Though they don’t always cop to it, a goodly number of senior business leaders pay very good money — I’ve heard quotes as high as $10,000 a year — for the help of an executive coach. Part high-end consultant, part amateur therapist, executive coaches help VPs and C-suite execs make better decisions by giving them an unvarnished view of their current situation and the inspiration to carry out their most ambitious plans.

This may have something in common with bringing on a partner like, say, Deloitte, but it’s decidedly different. While executive coaches may have worked in a bigshot consulting firm like PwC, their relationship is decidedly with the individual, and a trusted one at that.  The process of executive coaching sounds like a very useful one. (I’ll probably try it someday — when I have $10,000 to spare!)

The thing is, while I could be missing something, I’ve never heard so much as a hint that senior HIT executives are retaining executive coaches. It makes me wonder whether CtOs and VPs of IT still define their job largely by technical skills rather than their capacity for making strategic decisions with hospital- or system-wide implications.

The inescapable reality is that HIT execs have long outgrown supergeek status and are increasingly a key part of their healthcare organization’s future. So if they’re open for growth, HIT leaders may very well want to test out the executive coaching model, particularly in working out the following:

  • ACO development:  While the ACO contracting and development process may be led by other departments, health IT leaders have the power to make or break these agreements by how they support then. A VP of business development may spearhead such efforts, but it’s the health IT exec who will make or break how effectively the ACO handles population health support, risk management, data analytics and more.
  • Managing digital health: I hardly need to remind HIT execs of this, but the most important directives as to how to work with digital health tools aren’t going to come from the CEO down, but from the CIO or VP up. With the healthcare industry just beginning to grasp the value app-laden smartphones and tablets, smart watches, sensor-laden clothing, telemedicine and other rapidly emerging  technologies can bring, it’s the health IT exec who must lead the charge. And that means knowing how to solve critical business problems that extend well beyond IT’s boundaries.
  • EMR transformation: As hard as you’ve worked on implementing and tuning your EMR, it’d be nice to think you could stick a fork in it and consider it done.  But EMRs are having new demands placed on them seemingly every day, including integration of massive volumes of wearables and other patient-generated data; number-crunching and making sense of population health data; connecting revenue cycle management functions with EMRs and much more.  Deciding how to handle this spectrum of issues is the job of a business/tech thinker, not solely an IT guru.

Look, I’m not suggesting that the executive coaching is for everyone, health IT executives included. But I do believe that the right kind of executive coaching relationship could help HIT leaders to make a smoother transition into the even more critical role they are inheriting today. And anything that supports that transition is probably worth a shot.

GE Phasing Out Centricity Enterprise, To Some Surprise

Posted on April 22, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of 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.

Conceding that its competitors have the upper hand, GE is phasing out its Centricity Enterprise product, informing the world in a #HIMSS15 announcement which has gotten little play from our tech media colleagues.  As we’ve argued before, HIMSS is not only a great time to announce big plays, it’s also a great time to bury unpleasant news, and GE seems to have succeeded.

Not surprisingly, employees saw things coming long ago. More than a year ago, for example, a 10-year-plus employee of GE Healthcare called the vendor out on what they saw as low-wattage efforts on company rating site Glassdoor.com. The ex-employee cited a “lack of resources to deliver a good EHR product, [causing] a strong customer base to choose other EHR vendors.”

It’s little wonder that GE is backing out of Centricity Enterprise, which according to a report in MedCity News generated only 5 percent of its EMR revenue, according to Jon Zimmerman, general manager of clinical business solutions. “Is it in the best interest of our customers, shareholders and employees to (be) in a market where competitors are clearly ahead, or should we recognize the situation and go to where the market is going?” Zimmerman told MedCity.

But the fact is, Zimmerman’s comments are somewhat disingenuous. At HIMSS, the company admitted that it had begun the process of dumping Centricity Enterprise three years ago, though it’s not clear how long ago it began to let customers know about its plans. For example, I doubt that Continuum Health Partners CIO Mark Moroses, who as of summer 2013 was moving his organization to the Centricity enterprise EMR, expected to have it phased out less than two years later.

It’s worth wondering why a player with GE’s resources seemingly couldn’t hack the enterprise market. But the problem isn’t new. As far back  as 2011, GE was forced to admit that some of its ambulatory and enterprise customers wouldn’t be able to achieve Meaningful Use with their products. That was probably the beginning of the end for the Enterprise product, which ranked either fifth or sixth in the market recently depending on who you asked. But with Epic alone controlling 15% to 20% of the enterprise EMR market of late, and Cerner hot on its heels, giving up probably was a reasonable response.

The real question is what comes next. If Glassdoor.com posters are any indication, GE Healthcare is prone to frequent strategic changes as management shifts, so who knows what the future holds for its ambulatory Centricity EMR?

At the moment,  it seems that GE is firmly behind its ambulatory product. And that makes sense. After all, physicians are decommissioning their existing EMRs at a frantic rate, and are eager to find substitutes, and that gives GE plenty of sales opportunities. With 70% of physicians unhappy with their EMR, according to a study announced in February of last year, it should be easy pickins.

But given the way GE may have fumbled the ball on the enterprise side, I’d want some proof that leaders there had a long-term commitment to ambulatory care. Practices have a hard enough time finding EMRs that work for them; having to switch for reasons that have nothing to do with them makes no sense.

Meaningful Use Reporting Period Changed to 90 Days and Other Proposed Changes

Posted on April 10, 2015 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 case you missed the news, CMS posted the proposed rule that modifies meaningful use in 2015-2017 (Here’s the rule on the Federal Register). The 210 page document dropped late on Friday right before HIMSS. If you think we’ve seen CMS do this before, we’ve seen it happen a lot. They love to issue the rules on Friday and often right before HIMSS. At least that’s better than when they released the rule during HIMSS, but not much.

The summary of the changes is pretty straightforward:

  • Streamlining reporting by removing redundant, duplicative, and topped-out measures
  • Modifying patient action measures in Stage 2 objectives related to patient engagement
  • Aligning the EHR reporting period for eligible hospitals and CAHs with the full calendar year
  • Changing the EHR reporting period in 2015 to a 90-day period to accommodate modifications

The patient engagement was changed from 5% to a single download, view, and transmit as it’s been called. I think many will look on this as a very favorable change since you can’t force a patient to do something and so your incentive and penalties shouldn’t depend on their action.

It also makes sense that they change the hospital reporting period to the calendar year like it’s been for EPs. The change probably has some logistical questions for many hospitals, but it will make the process cleaner.

The big one of course is the 90 day attestation period. We knew it was coming and I think everyone’s glad that it’s here. Now it will be interesting to see how many wait until October to start their attestation period. That’s pretty risky if you ask me, but that didn’t stop organizations from waiting just the same.

I don’t think there will be many issues with what’s in this proposed rule. Although, we’ll see over the next week what other things people find as they dig into the rule. I know many were waiting for this to drop and are now breathing a sigh of relief over the 90 day reporting period.

Let us know in the comments if there are other details you find that we didn’t talk about or nuances we might have missed. Enjoy the light reading on the flight to HIMSS.

1/5th of Hospital EHRs are Poor Fits

Posted on April 6, 2015 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.


This is a really fascinating stat from Black Book. I’d like to dig into their methodology for this question. Defining what’s a “poor” fit is really hard when you realize that a poor fit is defined by hundreds and possibly thousands of EHR users in a hospital.

What I’ve found is that it’s really hard to make broad statements about EHR satisfaction at a hospital. The doctors may hate it, but the executives love it. The front desk may be annoyed by it, but the pharmacy is really happy. The nurses may love it…ok…I don’t think I know of any EHR that’s loved by nurses, but that’s a discussion for another blog post. Nurses often get left out in the EHR design and we’ll leave it at that for now.

With that disclaimer, let’s think about what it means that 20% of hospital EHRs are a poor fit. Does that mean that we’re going to see a wave of EHR switching in the hospital EHR world? I don’t think so.

The reason I don’t think so is that the hospital EHR is too expensive. Plus, changing EHR is so disruptive that you have to be really down on your EHR to actually switch. Sure, some of them are that down on their EHR that they’ll switch EHR. However, most of them don’t like it, but they aren’t ready to go through heart replacement surgery and take out their current EHR and replace it with a new one.

Some other factors at play is that they may not like their current EHR, but it’s the devil they know. That’s a powerful reason not to switch. Also, is there really a better alternative? Many who aren’t satisfied with their EHR aren’t convinced that switching to another EHR will be much better. Plus, many of these organizations are in the middle of meaningful use. If you switch EHR vendors in the middle of meaningful use, you might as well announce that you’ll be taking a year off from meaningful use (and all that entails…ask Intermountain).

While I don’t think we’ll see a wave of immediate EHR switching, once the renewal licenses come up, we’ll see more switching of EHR. Plus, if someone can come out with a high quality cloud based EHR for hospitals, then that could help with switching costs as well. However, until then, hospitals have mostly chosen their horse and now they have to ride it out. Of course, this assumes they don’t get acquired by a larger hospital system and are forced to switch EHR. That’s happening in a big way and is likely to continue.

The Future of…Healthcare IT

Posted on March 23, 2015 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.

As part of HIMSS 2015, they’re holding a blog carnival where people throughout the healthcare IT community can contribute blog posts covering 5 different topics. Each topic looks at “The Future of…” and then “Connected System, Big Data, Security, Innovation, and Patient Engagement.” I thought the topics were quite interesting, so I created a post for each of the 5 topics. Here’s links to each of them:

I’d love to have you chime in on each of the topics that interest you. Let me know if you agree or disagree with my commentary and prognostication. Even better, feel free to write your own blog post on any or all of these topics. They are important topics that will make up much of what happens in healthcare IT.

Are there any other “Future of…” topics you wish would have been discussed?