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Avoiding Revenue Crunches During EMR Transitions

Posted on May 23, 2016 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 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

Most healthcare leaders know, well before their EMR rollouts, that clinical productivity and billings may fall for a while as the implementation proceeds. That being said, it seems a surprising number are caught off guard by the extent to which payments can be lost or delayed due to technical issues during the transition. This is particularly alarming as more and more hospitals are looking at switching EHR.

Far too often, those responsible for revenue cycle issues live in a silo that doesn’t communicate well with hospital IT leadership, and the results can be devastating financially. For example, consider the case of Maine Medical Center, which took a major loss after it launched its Epic EMR in 2012, due in part to substantial problems with billing for services.

But according to McKesson execs, there’s a few steps health systems and hospitals can take to reduce the impact this transition has in your revenue cycle. Their recommendations include the following:

  • Involve revenue cycle managers in your EMR migration. Doing so can help integrate RCM and EMR technologies successfully.
  • Create a revenue cycle EMR team. The team should include the CFO, revenue cycle leaders from patient access and reimbursement, vendor reps and someone familiar with revenue cycle systems. Once this team is assembled, establish a meeting schedule, team roles and goals for participants. It’s particularly important to designate a project manager for the revenue cycle portion of your EMR rollout.
  • Before the implementation, research how RCM processes will be affected by the by the rollout, particularly how the new EMR will impact claims management workflow, speed of payment and staff workloads. Check out how the implementation will affect processes such as eligibility verification, registration data quality assurance, preauthorization and medical necessity management, pre-claim editing and remittance management.
  • Pay close attention to key performance indicators throughout the transition. These include service-to-payment velocity, Days Not Final Billed, charge trends and denial rates.

The article also recommends bringing on consultants to help with the transition. Being that McKesson is a health IT vendor, I’m not at all surprised that this is the case. But there’s something to the idea nonetheless. Self-serving though such a recommendation may be, it may help to bring in a consultant who has an outside view of these issues and is not blinkered by departmental loyalties.

That being said, over the longer term healthcare leaders need to think about ways to help RCM and IT execs see eye to eye. It’s all well and good to create temporary teams to smooth the transition to EMR use. But my guess is that these teams will dissolve quickly once the worst of the rollout is over. After all, while IT and revenue cycle management departments have common interests, their jobs differ significantly.

The bottom line is that to avoid needless RCM issues, the IT department and revenue cycle leaders need to be aligned in their larger goals. This can be fostered by financial rewards, common performance goals, cultural expectations and more, but regardless of how it happens, these departments need to be interested in working together. However, unless rewards and expectations change, they have little incentive to do so. It’s about time hospital and health system leaders address problem directly.

Health IT Software Must Be Meaningful and Pleasurable

Posted on April 27, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most dynamic healthcare CIO’s is Shafiq Rab, MD, MPH, Vice President and CIO at Hackensack UMC. Healthcare Scene was lucky enough to talk with him at the DataMotion Health booth during HIMSS 2016. Dr. Rab talked with us about Hackensack UMC’s approach to healthcare IT innovation. He offered some great insights into how to approach any healthcare IT project, about Hackensack University Medical Center’s “selfie” app, and their efforts to use Direct and FHIR to empower the patient.

I love that Dr. Rab leads off the discussion with the idea that healthcare IT software that they implement must be meaningful and pleasurable. Far too many health IT software miss these important goals. They aren’t very meaningful and they’re definitely not pleasurable.

Dr. Rab’s focus on the patient is also worth highlighting. Health IT would be in a much better place if there was a great focus on the patient along with making health IT software meaningful and pleasurable. Thanks Dr. Rab and DataMotion Health for doing this interview with us.

Tablets Star In My Fantasy ED Visit

Posted on April 1, 2016 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 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

As some readers may know, in addition to being your HIT hostess, I cope with some unruly chronic conditions which have landed me in the ED several times of late.

During the hours I recently spent being examined and treated at these hospitals, I found myself fantasizing about how the process of my care would change for the better if the right technologies were involved. Specifically, these technologies would give me a voice, better information and a higher comfort level.

So here, below, is my step-by-step vision of how I would like to have participated in my care, using a tablet as a fulcrum. These steps assume the patient is ambulatory and fundamentally functional; I realize that things would need to be much different if the person comes in by ambulance or isn’t capable of participating in their care.

My Dream (Tablet-Enabled) ED Care Process

  1. I walk through the front door of the hospital and approach the registration desk. Near the desk, there’s a smaller tablet station where I enter my basic identity data, and verify that identity with a fingerprint scan. The fingerprint scan verification also connects me to my health insurance data, assuming it’s on file. (If not I can scan my insurance card and ID, and create a system-wide identity status by logging a corresponding fingerprint record.)
  2. The same terminal poses a series of screening questions about my reasons for walking into the ED, and the responses are routed to the hospital EMR. It also asks me to verify and update my current medications. The data is made available not only to the triage nurse but also to whatever physician and nurse attend me in my ED bed.
  3. When I approach the main registration desk, all the clerks have to do is put the hospital bracelet on my wrist to do a human verification that the bracelet a) contains the right patient identity and b) includes the correct date of birth for the person to which it is attached. If the clerks have any additional questions to pose — such as queries related to the patient’s need for disability accommodations  — these are addressed by another integrated app the clerk has on their desk.
  4. At that point, rather than walking back to an uncomfortable waiting room, I’m “on deck” in a comfortable triage area where every patient sits in a custom chair that automatically takes vital signs, be it by sensor, cuff or other means. In some cases, the patient’s specific malady can be addressed, by technologies such as AliveCor’s mobile cardiac monitoring tool.
  5. When the triage nurses interview me, they already have my vitals and answers to a bunch of routine clinical questions via my original tablet interaction, allowing them to focus on other issues specific to my case. In some instances this may allow the staff to move me straight to the bed and ask questions there, saving initial triage time for more complex and confusing cases.
  6. As I leave the triage area I am handed a patient tablet which I will have throughout my visit. As part of assigning me to this tablet my fingerprint will again be scanned, assuring that the information I get is intended for me.
  7. When I am settled in a patient bed in the ED, I’m given the option of either holding the tablet or placing on a swing-over bed desk which can include a Bluetooth keyboard and mouse for those that find touchscreen typing to be awkward.
  8. Not long after I am placed in the bed, the hospital system pushes a browser to the tablet screen. In the browser window are the names of the doctor assigned by case, the nurse and tech who will assist, and whenever possible, photos of the staff involved. In the case of the doctor or NP, the presentation will include a link to their professional bio. This display will also offer a summary of what the staff considers to be my problem. (The system will allow me to add to this summary if I feel the triage team has missed something important.)
  9. As the doctor, nurse and tech enter the room, an RFID chip in their badges will alert the hospital system that they have done so. Then, a related alert will be pushed to the patient tablet – and maybe to the family members’ tablet which might be part of this process — giving everyone a heads up as to how they’re going to interact with me. For example, if a tech has entered to draw blood, the system will not only identify the staff member but also the fact that they plan a blood draw, as well as what tests are being performed.
  10. If I have had in interaction with any of the staff members before, the system will note the condition the patient was diagnosed with previously when working with the clinician or tech. (For example, beside Doctor Smith’s profile I’d see that she had previously treated me for stroke-like symptoms one time, and a cardiac arrhythmia before that.)
  11. As the doctor or NP orders laboratory tests or imaging, those orders would appear on a patient progress area on the main patient ED encounter page. Patients could then click on the order for say, an MRI, and find out what the term means and how the test will work. (If a hospital wanted to be really clever, they could customize further. For example, given that many patients are frightened of MRIs, the encounter page would offer the patient a chance to click a button allowing them to request a modest dose of anti-anxiety medication.)
  12. As results from the tests roll in, the news is pushed to the patient encounter home page, scrolling links to results down like a Twitter feed. As with Twitter, all readers — including patients, clinicians and staff — should have the ability to comment on the material.
  13. When the staff is ready to discharge the patient — or the doctor has made a firm decision to admit — this news, too, will be pushed to the patient encounter homepage. This announcement will come with a button patients can click to produce a text box, in which I can type out or dictate any concerns I have about this decision.
  14. When I am discharged from the hospital, the patient encounter homepage will offer me the choice of emailing myself the discharge summary or being texted a link to the summary. (Meanwhile, if I’m being admitted, the tablet stays with me, but that’s a whole other discussion.)

OK, I’ll admit that this rather long description caters to my prejudices and personal needs, and also, that I’ve left some ideas out (especially some thoughts related to improving my interaction with on-call specialists). So tell me – does this vision make sense to you? What would you add, and what would you subtract?

P.S.  Some high-profile hospitals have put a lot of work into integrating EMRs with tablets, at least, but not in the manner I’ve described, to my knowledge.

P.S.S. No this is not an April Fool’s joke. I’d really like for someone to implement these workflows.

NYC Epic Rollout Faces Patient Safety Questions

Posted on March 30, 2016 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 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

In the summer of last year, we laid out for you the story of how a municipal hospital system’s Epic EMR installation had gone dramatically south since its inception. We told you how the New York City-based Health and Hospitals Corp. was struggling to cope with problems arising from its attempt to implement Epic at its 11 hospitals, four long-term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.

At the time of last writing, the project budget had exploded upward from $302 million to $764 million, and the public chain’s CTO, CIO, CIO interim deputy and project head of training had been given the axe. In the unlikely event that you thought things would settle down at that point, we bring you news of further strife and bloodshed.

Apparently, a senior clinical information officer with the chain’s Elmhurst and Queens Hospital Centers has now made allegations that the way the Epic install was proceeding might pose danger to patients. A New York Post article reports that in a letter to colleagues, outgoing HHC official Charles Perry, M.D. compared the EMR implementation process to the 1986 Challenger space shuttle disaster.

In his letter, Dr. Perry apparently argued that the project must be delayed. According to the Post, he quoted from a presidential panel report on the disaster: “[For] a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Another Post article cited anonymous “insider” sources claiming that the system will crash, as the implementation is being rushed, and that the situation could lead to patient harm.

For its part, HHC has minimized the issue. A spokesperson told FierceHealthIT that Perry was associate executive director of the Elmhurst hospital and liason to the Queens Epic project, rather than being CMIO as identified by the Post. (Further intrigue?) Also, the spokesperson told FHIT that “if a patient safety issue is identified, the project will stop until it is addressed.”

Of course, the only people who truly know what’s happening with the HHC Epic implementation are not willing to go public with their allegations, so I’d argue that were obligated to take Perry’s statements with at least a grain of salt. In fact, I’d suggest that most large commercial Epic installations (and other large EHR implementations for that matter) got the scrutiny this public hospital system gets, they’d probably look pretty bad too.

On the other hand, it’s fair to say that HHC seems to crammed enough scandal into the first few years of its Epic rollout for the entire 15-year project. For the sake of the millions of people HHC serves, let’s hope that either there is not much to these critiques — or that HHC slows down enough to do the project justice.

GE Healthcare Is Still In The Game

Posted on March 14, 2016 I Written By

David is a global digital healthcare leader that is focusing on the next era of healthcare IT.  Most recently David served as the CIO at an academic medical center where he was responsible for all technology related to the three missions of education, research and patient care. David has worked for various healthcare providers ranging from academic medical centers, non-profit, and the for-profit sectors. Subscribe to David's latest CXO Scene posts here.

Below is the recent press release from GE Healthcare.  Their EMR will be used in the Rio 2016 Olympics which is a great win for GE.  The product has come a long way and they are making some great strides.  The challenge is where will the product fall in a healthcare EMR ecosystem that is predominately Epic and Cerner.   Personally I know of a few organizations that are evaluating a transition away from the GE Centricity platform due to either a merger with a bigger healthcare system that already has an enterprise EMR or they had a bad experience with Centricity and are moving on.  It will be interesting to see in the next 2-3 years how many EMR vendors we will have left.  I will definitely keep an eye on GE to see whether the recent win with the Olympic games will help create positive momentum in 2016.

LAS VEGAS–GE Healthcare announced today the International Olympic Committee (IOC) has selected the company’s Centricity Practice Solution as the official electronic medical record (EMR) to be used by the medical teams of the Rio 2016 Olympic Games. This marks the first time that all athletes and spectators at the Olympic Games will have their health interactions managed by an electronic medical record. The announcement was made at the 2016 Health Information Management Systems Society (HIMSS) conference in Las Vegas.

Centricity Practice Solution will be used for managing data related to injuries and illness for athletes competing in the games as well as spectators, officials, athlete family members and coaches who require medical assistance throughout the Rio 2016 Olympic Games. For the competitors, the data managed during the Games will be used to help drive optimal, individualized care to help athletes compete at a world-class level.

“The Olympic Games is about providing the best possible service to athletes,” said Dr. Richard Budgett, Medical and Scientific Director for the IOC. “The gold medal of medical services is something that is integrated and comprehensive: a total package. Adding access to an electronic medical record is key to our drive towards the prevention of injury. Without a proper medical, longitudinal record, it’s difficult for us to do surveillance and see what injuries are most common in certain sports. This would impact our ability to prevent and measure our effectiveness. The EMR is going to be a cornerstone for our medical services going forward.”

Centricity Practice Solution will be available in English and Portuguese and will provide access to next generation workflows, analytics and data to potentially help optimize athlete performance. The information will be analyzed to spot patterns and provide insights for future Games planning. Additionally, medical teams will be able to access diagnostic images and reports from within the EMR to assist in providing world-class care quickly and efficiently. GE’s EMR will be accessible at any of the multiple medical posts throughout the Games and at the central Polyclinic in the Olympic Village where more complex care is delivered.

“By selecting Centricity Practice Solutions EMR, the IOC is extending the clinical care and data management capabilities pioneered by the United States Olympic Committee (USOC), which has used GE’s EMR platform for the past two Olympic Games in London and Sochi,” said Jon Zimmerman, General Manager, GE Centricity Business Solutions. “Incorporating an EMR platform into the healthcare services will enable medical staff at the Rio 2016 Olympic Games access to real time data, analytics and health information to help their athletes perform at peak capabilities.”

If you’d like to receive future health care C-Level executive posts by David in your inbox, you can subscribe to future Health Care CXO Scene posts here.

Does Green Mean Go? The Importance of Transparency in Status Reporting

Posted on February 19, 2016 I Written By

For the past twenty years, I been working with healthcare organizations to implement technologies and improve business processes for nearly twenty years. 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 common method of reporting project status is to use the familiar traffic light system, with a status of green, yellow and red. This method of reporting, in theory, makes it easy to determine whether a project is on track and allows the reader to glance quickly at a status report and determine whether there is any cause for concern that requires their attention.

A status of green simply suggests that no such action is necessary, and that the reader has no required actions. A status of yellow or red may require some discussion or resolution. In concept, this system makes sense and allows a project sponsor, who is likely involved in multiple projects and has limited time for each, to quickly determine which projects require their attention.

In reality, this system results in a false sense of security regarding the status of a project and often covers up issues that require attention until they inevitably become serious, at which point the result is most often a project delay, an increase in budget, or more often than not, both.

No project is perfect
The reality is that any project that will result in real change in your organization — including software implementations, cost savings initiatives, and organizational changes — will have problems. It is not the existence of problems that will make or break the success of a project; it is how these problems are addressed. Addressing a problem properly almost always requires early identification and action. Too often, the status reporting system delays the identification of problems, causing them to fester and build to the point at which they can no longer be easily repaired.

The politics of project status
Status reports are inevitably a very political process as the project manager must gather information from the leads or key members of the project team who are completing sets of tasks. In some cases, the project manager is an employee who is overseeing a combination of internal and external resources to complete a project. Quite often, the reverse is true, where the project manager is an external resource who is managing a combination of internal and external resources.

Regardless, the motivations of project managers are in conflict. They want to ensure that they report issues early enough that they can be addressed, but have to balance multiple political realities.  A project manager must be careful not to burn bridges and gain the trust of the team members. Changing a status report to yellow will increase the pressure on team members and potentially make them look bad to their management. Those team members may resent the project manager for the action and be reluctant to share information with him or her in the future.

Therefore, a project manager will often hide the truth, buying the team time to address the issue on its own before escalating the issue by properly reporting the actual status of the project. The result is that often the status that appears on a report is a matter of negotiation between the project manager and the respective team members.

This issue can be even more significant when the project manager is an external contractor managing a project that includes resources from the same company. The project manager in this case has a split loyalty. The first is to the project, and the second is to the employer. To protect the employer, project managers might be reluctant to report a status that will indicate a delay or issue caused by their team, resulting in overly optimistic status reports that hide the project realities.

This is further complicated by the reality that status, particularly status with a green-yellow-red option, is highly subjective. One might interpret a red status as one that is halting the project, but a problem could have serious implications down the line even if it is not halting the project today. A green status could be interpreted as one in which the project remains on track even if there are issues.

Properly reporting status
How does a project sponsor ensure that the true status of a project is reported?

First, there needs to be an acceptance that the status of a complex project cannot be simplified into the equivalent of a system that is designed to let us know whether it’s safe to proceed through a traffic light. Sponsors must be prepared to take the time to fully read through reports and understand the events and issues that have occurred and be prepared to ask questions to challenge the project manager and team leads about the urgency of any issues to see if they require sponsor involvement.

Second, project managers and team members need to be informed that the expectation is that all issues, challenges, and risks will be raised in status reports and status meetings without any fear of repercussions from project sponsors or project team members. These issues should be included in status reports, even if resolved before the report is created, to create visibility into any challenge the project has to overcome. The discussion about issues in status meetings should be open and honest, with proposed solutions provided by team members. Often issues can be resolved timely with the proper allocation of resources, expedited decision making, or simply through discussion.

Finally, the motivations of the project manager must be considered and factored into discussions. In many cases it may be preferable to have the project manager be an internal resource or an external resource that is not from the same company as your implementation or software partner. In cases where they are the same, extra attentiveness to the status and issues presented should be considered to ensure that the reports are being prepared without bias.

While the green-yellow-red method may allow for efficient review of status reporting, it can lead to missing the important details of the actual status that are vital to the success of the project. Proper communication can ensure that red lights change to yellow, and yellow to green, ensuring that the project will not face a true stopping point at a critical point, leading to costly delays.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here.

The Amazon Echo – Bringing Sci Fi Reality to Healthcare

Posted on February 16, 2016 I Written By

David is a global digital healthcare leader that is focusing on the next era of healthcare IT.  Most recently David served as the CIO at an academic medical center where he was responsible for all technology related to the three missions of education, research and patient care. David has worked for various healthcare providers ranging from academic medical centers, non-profit, and the for-profit sectors. Subscribe to David's latest CXO Scene posts here.

My initial impression of the Amazon Echo was that this is simply a Bluetooth speaker that looks like a portable humidifier with a little bit of artificial intelligence. The next thing I discovered is that the Echo always needs to be plugged in for it to work. But then, after playing around with it, I realized that the Amazon Echo is actually quite impressive.

The Echo introduces the handy Alexa function. The initial conversations with Alexa are very simple. You can ask about the weather, the time, sports results, or the latest news. But with time, I learned that Alexa could even read an audio book; tell me about the local businesses; and where to go for a Thai dinner.

The other benefit of Echo its accessibility and quality. It comes with a remote control or you may control it via your mobile device after downloading the Amazon echo app. The bottom part of the Echo has a 360-degree speaker that surprisingly fills the entire room with sound. Even at a distance of 9-10 feet Alexa can pick up commands.

Because of the sophisticated voice activated system, the Echo has great potential for use by patients in a healthcare setting. The main use case that I see is in the hospital’s patient room. Let’s think of a scenario where we have a 50-year-old patient in the hospital that had just gone through a surgery procedure and is expected to be in the hospital for two days. Echo can be a great device to allow personalization such as: integration to the patient’s Spotify music, control of the room temperature and blinds, the ability to order an Uber for the patient’s family, as well as many other features of a smart home. The goal will be to bring the technology of a smart home into a patient’s room to enhance the patient’s experience away from home.

From a clinical perspective, the Echo can assist the medical provider by reciting the medical education transcribed by the doctor to the patient, such as: the side effects of a prescription drug that the patient should expect for the next month after surgery. If we go back to the example of the patient who is recovering from surgery and has been prescribed drugs, the Echo can either be a replacement or an integrated device for the nurse call system where the patient can ask for pain medication through Echo. In addition, patients can also order their meals through the device if it is integrated with the dietary system in the hospital. As such, the voice-activated system would clearly be a great two-way communication tool for the patient who may not be able to move from their bed with ease.

As healthcare is moving towards the goal of creating the best patient experience possible, we have to start integrating consumer products with the strategy of providing a hotel-like experience in an inpatient room. The integration of smart room technology and voice activation communication has become an invaluable part of luxury hotels, and likewise, we must attempt to replicate that same kind of technology and convenience in hospitals.   I have personally witnessed a lot of success by international hospitals incorporating the hotel experience into their culture to improve patient experience. Similarly, I believe that hospitals in the US must start to adjust our strategy in order to meet the expectation of today’s consumer-patients.

If you’d like to receive future health care C-Level executive posts by David in your inbox, you can subscribe to future Health Care CXO Scene posts here.

HIMSS Puts Optimistic Spin On EMR Value Data

Posted on February 5, 2016 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 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

After several years of EMR deployment, one would think that the EMR value proposition had been pretty well established. But the truth is, the financial and clinical return on EMRs still seems to be in question, at least where some aspects of their functioning are concerned.

That, at least, is what I took from the recent HIMSS “Value of Health IT Survey”  released earlier this month. After all, you don’t see Ford releasing a “Value of Cars Survey,” because the value of a car has been pretty much understood since the first ones rolled off of the assembly line more than a century ago.

Industry-wide, the evidence for the value of EMRs is still mixed. At minimum, the value proposition for EMRs is a remarkably tough case to make considering how many billions have been spent on buying, implementing and maintaining them. It’s little surprise that in a recent survey of CHIME members, 71% of respondents said that their top priority for the next 12 months was to realize more value from their EMR investment. That certainly implies that they’re not happy with their EMR’s value prop as it exists.

So, on to the HIMSS survey. To do the research, HIMSS reached out to 52 executives, drawn exclusively from either HIMSS Analytics EMRAM Stage 6 or 7, or Davies Award winning hospitals. In other words, these respondents represent the creme de la creme of EMR implementors, at least as HIMSS measures such things.

HIMSS researchers measured HIT value perceptions among this elite group by sorting responses into one of five areas: Satisfaction, Treatment/Clinical, Electronic Information/Data, Patient Engagement and Population Management and Savings.

HIMSS’ topline conclusion — its success metric, if you will — is that 88 percent of execs reported at least one positive outcome from their EMR. The biggest area of success was in the Treatment/Clinical area, with quality performance of the clinical staff being cited by 83% of respondents. Another area that scored high was savings, with 81% reporting that they’d seen some benefits, primarily in coding accuracy, days in accounts receivable and transcription costs.

On the other end of the scale, execs had to admit that few of their clinical staffers are satisfied with their EMRs. Only 29% of execs said that their EMR had increased physician satisfaction, and less than half (44%) said their nurses were more satisfied. If that isn’t a red flag I don’t know what is.

Admittedly, there are positive results here, but you have to consider the broader context for this study. We’re talking about a piece of software that cost organizations tens or even hundreds of millions of dollars, upon which many of their current and future plans rest. If I told you that my new car’s engine worked and the wheels turned, but that the brakes were dodgy, fuel economy abysmal and the suspension bumpy, wouldn’t you wonder whether I should have bought it in the first place?

Tips For Young Healthcare Executives Managing Older Experienced Staff

Posted on February 2, 2016 I Written By

David is a global digital healthcare leader that is focusing on the next era of healthcare IT.  Most recently David served as the CIO at an academic medical center where he was responsible for all technology related to the three missions of education, research and patient care. David has worked for various healthcare providers ranging from academic medical centers, non-profit, and the for-profit sectors. Subscribe to David's latest CXO Scene posts here.

These days, it is not uncommon to see fresher and younger talents tackle management positions and working together with the more experienced and older colleagues. The number of executives that hold high corporate ranks while still in their 20s-30s has impressively grown through the years, despite the fact that seniority is generally a determining factor for promotion opportunities. This shifting corporate culture may bring about many different challenges to organizations, since younger CEOs and executives may struggle with supervising their employees, who are 10-20 years their senior. These older employees could feel discomfited when reporting to their younger employers and having to take directions from them. Nonetheless, there are several strategies that I have used in these situations, which may assist in bringing harmony and balance to these relationships.

Be clear with what you expect
Only the head of the department will be able to set the tone for the culture of the organization. It is the head of the department who will determine what will and will not be tolerated among the employees and the leadership team. As a young leader, whether you are the CEO, CIO, COO, CXO, or any other head of the department, you must be clear with the expectation and directions. Act like the leader of the department or of your team and communicate as much as possible to avoid any ambiguity.

Communicate consistently
One way of establishing better rapport with the older employees is to develop an understanding about their motivations, working attitude, needs, and values. To gain understanding, it is important that the employer and employees have regular conversations. A clear understanding of the employees’ motivations is critical for you to develop the organizational strategy. Your management strategy for an employee who is two years away from retiring is going to be a whole lot different from that for an employee who still has another ten or more years ahead of them before retirement.

However, as the head of the department, I believe that it is important to put the organization as a whole first before individual team members. In this regard, you should still strive to do what is best for both parties and always sympathize with the employee by putting yourself in their shoes and treating them the same way that you would like to be treated if the situation was reversed.

Address their weaknesses supportively
Younger executives should not be afraid to acknowledge the older employees’ weaknesses in a supportive manner. While it may be a widespread belief that older employees are likely to resist learning new things and are less likely to succeed in the digital era, I believe that this is a misconception. From my experience, there are actually a number of older workers who are more than eager to embrace new technologies. You will be able to encourage and assist such older employees to adapt to the new digital generation and be more comfortable with the technological changes by supporting them through use of manual demonstrations, tutorials, and various training programs.   Give these employees the benefit of the doubt and be patient, while assisting and insisting upon their endeavor to engage in learning and applying new technologies in this digital era. The experience must be a positive one to motivate any individual to change.

Tap their experience
Notwithstanding the above, older employees who choose to remain in the work place, even if they are approaching retirement age, also have a lot to offer to the department. They may be able to provide the younger leaders with valuable information and insight from their years of experience in the field. Having their experience tapped through executive mentoring in which the older colleagues are offering guidance and advice on certain cases could help you shape better strategies. Everyone has a story to tell and a lesson to teach that may be valuable for any leader, young or old. In turn, this form of communication could make the older employees feel appreciated and motivated.

Find balance and harmony
Notwithstanding the above, as a young leader, you still need to be clear with the older employees that, while you are giving value to their experience, you are still the leader of the team and the ultimate decision-maker. This requires a delicate balance between strength and sensitivity – specifically, a balance between being a strong leader and a sensitive mentor.

There are many approaches younger leaders can take to work well and successfully with older employees in a department. Some of these approaches have already been enumerated above. However, no matter what strategies are adopted, the key to being an effective young leader is to treat all employees with respect and dignity, while maintaining your authority. This way you will be able to ensure balance and harmony in your department, which will result in a strong work culture and successful operations in the business.

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EMR Usability A Pressing Issue

Posted on January 29, 2016 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 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

A few months ago, in a move that hasn’t gotten a lot of attention, the AMA and MedStar Health made an interesting play. The physicians’ group and the health system released a joint framework designed to rank EMR usability, as well as using the framework to rank the usability of a number of widely-implemented systems.

What makes these scores interesting is not that they’re just another set of rankings — those are pretty much everywhere — but that the researchers focused on EMR usability. As any clinician will tell you (and many have told me) despite years of evolution, EMRs are still a pain in the butt to use. And clearly, market forces are doing little to change this. Looking at where widely-used systems rate on usability is a refreshing look at a neglected issue.

To score the EMRs, researchers dug into EMR vendor testing reports from ONC. This makes sense. After all, though the agency doesn’t use this data for certification, the ONC does require EMR vendors to report on user-centered design processes they used for eight capabilities.

And while the ONC doesn’t base EMR certifications on usability, my gut feeling is that the data source is pretty reliable. I would tend to believe that given they’re talking to a certifying authority, vendors are less like to fudge these reports than any they’d prepare for potential customers.

According to the partners, Allscripts and McKesson were the highest-scoring EMR vendors, gaining 15 out of 15 points. eClinicalWorks was the lowest-scoring EMR, getting only 5 of 15 possible points. In-betweeners included Cerner and MEDITECH, which got 13 points each, and Epic, which got 9 points.

And here’s the criteria for the rankings:

  • User Centered Design Process:  EMRs were rated on whether they had a user-centered design process, how many participants took part (15+ was best) and whether test participants had a clinical background.
  • Summative Testing Methodology: These ratings focused on how detailed the use cases relied upon by the testing were and whether usability measures focused on appropriate factors (effectiveness, efficiency and satisfaction).
  • Summative Testing Results:  These measures focused on whether success rates for first-time users were 80% or more, and on how substantive descriptions of areas for improvement were.

Given the spotty results across the population of EMRs tested, it seems clear that usability hasn’t been a core concern of most vendors. (Yes, I know, some of you are saying, “Boy howdy, we knew that already!”)

Perhaps more importantly, though, it can be inferred that usability hasn’t been a priority for the health systems and practices investing in these products. After all, some of the so-so ratings, such as that for the Epic product, come from companies that have been in the market forever and have had the time to iterate a mature, usable product. If health systems were demanding that EMRs be easy to use, the scores would probably be higher.

Frankly, I can’t for the life of me understand why an organization would invest hundreds of millions of dollars (or even a billion) dollars in an EMR without being sure that clinicians can actually use it. After all, a good EMR experience can be very attractive to potential recruits as well as current clinicians. In fact, a study from early last year found that 79% of RNs see the hospital’s EMR as a one of the top 3 considerations in choosing where to work.

Maybe it’s an artifact of a prior era. In the past, perhaps the health systems investing in less-usable EMRs were just making the best of a shoddy situation. But I don’t think that excuse plays anymore. I believe more providers need to adopt frameworks like this one, and apply them rigorously.

Look, I know that EMR investment is a complex dance. And obviously, notions of usability will continue to evolve as EMRs involve — so perhaps it can’t be the top priority for every buyer. But it’s more than time for health organizations to take usability seriously.