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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 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 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.

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.

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 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 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.

Is An Epic Investment Bad For Health Leaders’ Job Stability?

Posted on January 28, 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 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.

For quite some time now, the buzz has been that at least one EMR vendor was a safe bet for everyone involved. “No one ever got fired for choosing Epic” has begun to seem as obvious a sentiment as “No one ever got fired for choosing IBM” in hospital C-suites. And certainly, in previous times that was probably true.

But it’s beginning to look as though at least in some cases, Epic has not been as safe a choice as health execs had hoped. In fact, while it’s not exactly a fully-fledged trend, it’s worth noting that Epic-related costs and technical issues have led to job losses for hospital CIOs, as well as other operational leaders, in recent times.

Perhaps the most recent example of Epic-related job attrition took place earlier this month, when the chief information officer and chief operating officer of Denver Health Medical Center. According to the Denver Post, the two executives left their posts in the wake of major disagreements over the medical center’s big investment in an Epic EMR.

The Denver Post story reports that former Denver Health CIO Gregory Veltri was on the outs with CEO Arthur Gonzalez from the outset where Epic was concerned. Apparently, Veltri argued from the get-go that the Epic install costs — which he estimated could hit $300 million when the $70 million cost of dumping the center’s current EMR contract and doubling of its IT staff were computed — stood a chance of bankrupting the hospital. (Gonzalez, for his part, claims that the Epic installation is under budget at $170 million, and says that the system should go live in April.)

In another example of Epic-related turnover, the chief information officer at Maine Medical Center in Portland seems to have left his job at least in part due to the financial impact of the hospital’s $160 million Epic investment. Admittedly, the departure of CIO Barry Blumenfeld may also have been related to technical problems with the rollout which slowed hospital collections. This took place back in 2013, but it still seems noteworthy.

The spring of 2013 also saw the departure of Sheila Sanders, the chief information officer for Wake Forest Baptist Medical Center, in the midst of the medical center’s struggles to implement its own Epic system. While Wake Forest Baptist had spent a comparatively modest $13.3 million on direct Epic costs during its second quarter of fiscal 2012-13, the medical center had been socked by delays in revenue resulting to Epic rollout problems, including issues with billing, coding and collections.

Wake Forest Baptist reported taking an $8 million hit that quarter due to “business-cycle disruptions (that) have had a greater-than-anticipated impact on volumes and productivity.” It also reported $26.6 million in lost margin due to reduced volume during go-live and post go-live Epic optimization.

Of course, a botched rollout can mean job insecurity no matter what EMR the hospital has chosen. For example, in May of 2014, Athens Regional Medical Center President and CEO James Thaw was apparently pressured out of office when the facility’s Cerner rollout went poorly. (After weeks of Cerner problems, the hospital’s staff voted 270-0 that they had “no confidence” in the hospital’s leadership. Gulp!) Somehow, Senior Vice President and CIO Gretchen Tegethoff kept her job, but my bet is that it was a close-run thing.

And to be fair, this is obviously a small, selected set of anecdotes about questionable Epic rollouts. They don’t prove that Epic is a CIO job killer or an ineffective EMR. But these stories do highlight the fact that while Epic investments might yield good things, rolling Epic out requires nerves of steel and flawless execution.

Great Healthcare IT Leaders

Posted on January 25, 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.

As we prepare for the upcoming HIMSS conference on Feb 29 – Mar 4, 2016, I encourage the community to connect with these top thought leaders who will go above and beyond in engaging with the community. Looking forward to catching up in Vegas.
himss16 cio

Aaron Miri CIO at Walnut Hill Medical Center @AaronMiri 
Anna Turman CIO at Chadron Community Hospital and Health Services @iamTurman
Chad Eckes Board Member at NC HIMSS
Chris Belmont CIO at MD Anderson Cancer Center @CBelmont88 
Cletis Earle CIO at St. Luke’s Cornwall Hospital
Cris Ross CIO at Mayo Clinic
Darren Dworkin CIO at Cedar Sinai Medical Center @DworkinDarren
Dave Miller CIO at Optimum Healthcare IT @dlmilleroptimum
Dick Escue CIO at Valley View Hospital
Drex DeFord CIO Advisor @drexdeford 
Edward Marx CIO at The Advisory Board @marxists
Gareth Sherlock CIO at Cleveland Clinic Abu Dhabi
Gene Thomas CIO at Memorial Hospital of Gulfport
James Brady CIO, Kaiser Permanente Orange County
Jay Ferro CIO at American Cancer Center @jayferro 
John Delano CIO at Integris health
John Halamka CIO at Beth Israel Deaconess Medical Center @jhalamka
John Jay Kenagy CIO at Legacy Health
Jon Manis CIO at Sutter Health
Joseph Hobbs Regional CIO at NetApp @JOEtheCIO 
Kristin Darby CIO at Cancer Treatment Centers of America @khdarby
Marc Chasin CIO & CMIO at St. Luke’s Health System @M_Chasin
Marc Probst CIO at Intermountain Health @probst_marc
Michael Archuleta CIO at MT San Rafael Hospital @Michael81082
Mike Reagin CIO at Sentara Healthcare
Patrick Anderson CIO at Hoag Memorial
Pravene Nath CIO at Stanford Health @pravenenath
Robin Sarkar CIO at Lakeland Regional Health System
Sarah Richardson CIO at NCH Healthcare System @conciergeleader 
Scott Maclean Deputy CIO at Partners Health @stmaclean
Shafiq Rab CIO at Hackensack University Medical Center @CIOSHAFIQ
Steve Huffman CIO at Beacon Health System @SteveHuffman_IN
Steve Stanic CIO at Baptist Health (Jackson, MS)
Sue Schade CIO Advisor @sgschade 
Todd Richardson CIO at Aspirus
Will Weider CIO at Ministry Health @CandidCIO 

Let us know if you think there’s someone else you think we should add to the list. We always love to learn about new people that are worth following.

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.

Social Media 101 For Healthcare CXOs – Part 2

Posted on January 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.

This is a follow up to my last blog post regarding social media for CXOs.   I increased my action on social networking sites around four years ago when another new employment in Abu Dhabi forced a vast physical separation between me, my colleagues and critical emerging trends in healthcare IT back in the United States. I’ve been a daily Twitter and LinkedIn client from that point forward.

Social media provided the platform to build up solid associations and relationships with different influencers and pioneers in the industry. I also utilize social media to recruit talent, promote the organization’s achievements, speak internally with staff, and update everyone on rising trends.

Leaders who have a big department may not have the capacity to converse with each individual worker. I attempt to use social as one of the communication tool in addition to face-to-face time in order to share my thoughts about where we’re going from a strategy initiatives perspective. I also use the channel to share articles related to industry trends so people can keep up with what’s going on in the market.

My day by day online networking routine starts in the early mornings, before work, and after that continue in full drive following my workday. Social networking is not something you can simply say, ‘I’m going to go through an hour with it”,  You truly live it in small increments throughout your day.

Twitter as dynamic news feed
Twitter is currently my go-to news feed in the morning, and I utilize it to locate the most recent updates, news articles and critique on the healthcare business. Twitter is a decent place for individuals to share thoughts, or what’s at the forefront from the various industry thought leaders.  The majority of the Fortune 500 companies’ CEOs or executive groups are on Twitter sharing what’s happening to their businesses, and what’s happening with their organizations. This forum is a great place where you can get a genuine glimpse from the thought leader’s perspectives.  

I consider social important, however I don’t feel the need to post, or check in consistently.  On the off chance that I have a five-minute or 10-minute gap, I will examine what’s going on. I’ll check my notifications. However, I’m not always on my telephone checking the social stream.

LinkedIn for networking and career success
During the previous year, I began blogging, and I tried to routinely share thoughts on LinkedIn’s publishing platform. I appreciate the feedback I get on industry-specific topics and leadership. LinkedIn likewise allows me make and reinforce proficient connections for networking opportunities and professional success.

My Tips
Let me offer a few tips for CXOs who need to hone their social media methodologies from my experience.  First, CXOs ought to do all that they can to cooperate with their social connections. Use social to drive engagement, whether it’s with your associates, your staff or even your bosses. Listening is also key, and CXOs ought to grasp at the chance to act as a sounding boards for others. You truly need to listen and see what’s out there since many have alternate points of view that can expand your thinking on a topic.  

Lastly, CXOs have to invest the time to decide how social tools function best for them.   As I mentioned earlier, social can be an incredible tool for recruiting, department branding and personal branding. However, it takes exertion and work. It’s not something you can benefit from simply because you made a Twitter account and sat back waiting for people to follow you.

For me, social media is mostly a conduit for learning and a springboard to test ideas. Plus, it’s a platform to connect and engage with new thought leaders. If you are looking to jump start your learning and engagement, I definitely encourage everyone to get on a social media platform and start connecting and having discussions. Take the initial step to connect with others. You can start your initial discussion with me on the various social platforms I am using: Twitter, LinkedIn, and Facebook.

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.

What at CES Requires Immediate Action from Hospitals?

Posted on January 11, 2016 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 I process my week at CES (Formerly known as the consumer electronic show), I was blown away by all the amazing technology. This was true across a wide variety of spaces including drones, virtual reality (VR), 3D printing, smart homes, robotics, and yes digital health. 170,000 people at CES and over 20,000 products launched the week of CES means I missed a lot. However, I did get a chance to see a lot of the digital health solutions on display at CES. In fact, see most of my Digital Health coverage of CES on EMR and HIPAA.

While the event was enormous, the observation I’ve made most about digital health is that there was very little that was revolutionary when it comes to health care itself. Pretty much everything I saw was part of the evolution of digital health that we already understood. There was really no game changing technology, app, software, hardware or other solution that would dramatically change the course of healthcare.

In fact, if I were a hospital executive coming out of CES, I wouldn’t have any immediate action items on my list. Sure, there are a lot of fun technologies, but there really aren’t that many clinically relevant innovations at CES.

While I do think that’s the case today, I believe that’s going to change. If I were to compare digital health to the internet, we’re still working on compuserve or prodigy (Yes, those were the “internet” before their were web browsers). We don’t even have a great web browser developed and mobile computing wasn’t really even much of a thought. However, I see a lot of organizations starting to build something that innovative in healthcare. Plus, the building blocks are now in place that a unique entrepreneur will put together all these innovations in devices and data and create something that transforms healthcare.

Most hospitals aren’t entrepeneurs. So, the opportunities presented by digital health at CES aren’t that interesting. However, CES is a digital health entrepreneur’s playground. The opportunities to leverage technology to improve health are endless. The groundwork that’s been laid is amazing. It will just take a number of years for it to reach hospitals in a package that works for them.

HCA Builds Capacity For Resilience Into EMR Rollout Training

Posted on January 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 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 few weeks ago, Hospital Corporation of America had a rather substantial EMR outage. The outage, which was caused by a problem with storage hardware, lasted about 24 hours. It largely affected a portion of the 50 hospitals it operates in Florida, but some of the 115 HCA hospitals located outside Florida were impacted too.

Though large EMR outages are worth noting, my purpose in writing this blog is not to slam HCA. Actually, HCA staffers seem to have been prepared for the worst. In fact, according to an article from the Healthcare Financial Management Association, HCA built resiliency into its EMR rollout and operations process. And that is interesting indeed.

Hiring for talent and attitude

To roll out an EMR across its large network of hospitals, HCA leaders settled on an unusual strategy.  Rather than sign up a cadre of pure HIT specialists, HCA decided to hire professionals across a wide variety of disciplines.

As it turned out, all of the 120 EMR implementation specialists it hired were under age 30, with strong organizing, communication and collaborative skills. Their degrees included English, marketing and biomedical science.

Training for rollout

To train the newly-blessed specialists, HCA created hCare University. The new team members got four to six weeks of training, including both hands-on and classroom education, in vital skills such as working with clinicians and managing projects.

hCare University also taught the implementation specialists HCA’s EMR methodology, refining the approach — and how it taught that approach — over time. HCA trialed its methods at one pilot hospital, then two more, and eventually rolled it out to 20 to 40 hospitals at a time, HFMA reports.

Stressing inclusiveness and communication

As the rollout progressed, hCare teachers and system leaders continued to hammer home the importance of effective communication — and just as importantly, making sure that clinicians felt included.

“We probably spent as much, if not more, time on the people aspects as on the technology,” said consultant Mary Mirabelli, who oversaw the rollout, as well as HCA’s Stage 1 Meaningful Use efforts. “Because you’re expecting clinicians to exhibit new behaviors and embrace a system that is sometimes not well designed for their needs, you have to figure out ways to give them control and involve them in decision making.”

Now, I admit to being a bit biased, as I’m the kind of liberal arts jack-of-all-trades HCA relied on to supervise its rollout. And I want to emphasize that I’m not suggesting that traditional HIT hires are per-se inflexible!

That being said (having declared my prejudices), I would tend to believe that HCA is telling the truth when it asserts that staff confidently worked around the outage, despite its length and breadth.  I would assert that mixing in people whose primary skills are “soft” with HIT pros is an excellent way to support a resilient attitude when EMR problelms emerge.

Investing in people who can coordinate with all sides is actually good for HIT staffers. After all, doesn’t it benefit the HIT department when other folks are out there building good will, fostering cooperation and (in hopefully rare cases) minimizing damage to morale when snags or outages occur?

Maybe It’s Time To Phase Out The Meaningful Use Program

Posted on December 29, 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.

Since Stage 1 of the Meaningful Use incentive program kicked off in 2011, the level of health IT adoption has risen dramatically across the United States. As publicly-funded programs go, it’s had quite a ride.

A few years in, nearly 97% of U.S. hospitals had achieved Stage 1 or higher of the HIMSS EMR Adoption model (as of Q1 2015). And a plurality (roughly 57%) were at Stage 5 or higher.

Meanwhile, 83% of office-based doctors are now using EMRs, according to a recent report from ONC.  The percentage drops to 74% when counting only physicians using certified EMRs, but that’s still a very substantial increase over the 57% of office-based docs using EMRs in 2011.

Whether this progress was worth the $28.1 billion paid out (as of December 2014) is anyone’s guess, but clearly, the program had a huge impact. In fact, it’s hard to argue that MU payments helped to trigger a major change in how medicine is practiced.

That being said, some critics are floating the idea that it’s time to retire Meaningful Use, or at minimum, pull back its implementation dramatically. For example, HIT superstar John Halamka contends that Meaningful Use programs “have served their purpose.”

In his blog, Halamka — who serves as CIO of both the Beth Israel Deaconess Medical Center — suggests that Stage 3 of MU is little more than a multi-train pile-up (the following quote is long but deserves to be read in full):

 Stage 3 makes many of the same mistakes as Stage 2, trying to do too much too soon. It requires patient accessible Application Programming Interfaces (APIs) without specifying any standards.   It requires sending discharge e-prescriptions although pharmacies cannot widely support the cancel transaction that is essential to discharge medication management workflow.   It requires public health transactions but CMS has no authority to require public health authorities to standardize the way they receive data.

Clinicians cannot get through a 12 minute visit, enter the necessary Stage 3 data elements, reconcile problems/allergies/medications from multiple institutions, meet the demands of the  Stage 3 clinical quality measures, make eye contact with patients, and deliver safe medical care.

Having read the above, you won’t be surprised to learn that elsewhere, Halamka argues that Stage 3 of Meaningful Use should be dropped completely. Instead, he’d like to see the government offer merit-based rewards for positive outcomes and innovative approaches.

While Halamka’s arguments make a lot of sense, another group of people want to address the fact that the Meaningful Use program incentives have never been available to most mental health providers. As readers may know, mental health facilities such as psychiatric hospitals and substance abuse treatment facilities currently aren’t eligible for Medicaid and Medicare MU incentives. Also, front-line mental health professionals such as psychologists and licensed social workers are not included in the current definition of “eligible professionals.”

A bill progressing through the U.S. House of Representatives, H.R. 2646 (“Helping Families in Mental Health Crisis Act of 2015”) proposes to add clinical psychologists to the list of eligible professionals, and psychiatric hospitals, community mental health centers, residential or outpatient mental health and substance abuse treatment facilities to the list of eligible providers. While I’m not suggesting that Meaningful Use as currently structured is the only way to address the mental health industry’s HIT needs, those needs shouldn’t be forgotten. In fact, John would argue that not being involved in meaningful use might be the best thing that happened to mental health EHR.

I’d agree that eliminating — or at minimum transforming — the existing Meaningful Use program may be a good idea. Better to try something new than drag providers through a wasteful, painful rout.

Hospital CIO David Chou’s Top 3 Focuses for 2016

Posted on December 28, 2015 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.

As we wrap up 2015, here are three main focus areas that IT leaders must be prepared for in 2016

Mega Mergers / Affiliations are going to continue across the nation. Healthcare institutions realize that it pays to be big and it will be important to have the organizational size in order to be a player in the market. Almost every type of conceivable partnership is on track for the upcoming year. We have seen partnership between competitors (Kaiser and Dignity Health) that were unthinkable a few years ago. These types of creative partnership and affiliation will enable healthcare providers to regain the advantage against insurers when negotiating reimbursements and also gain best practices from each other to improve quality of care. We will also continue to see community hospitals collaborate with top tier healthcare systems and academic medical centers to generate more consumer options. To control costs, tertiary hospitals are rapidly moving care with lower acuity levels to the community hospitals.

Emerging Technologies such as smart-phones and patient tracking devices are catching on in healthcare and they will become the standard. Besides telling patients about the wait times in the emergency rooms, these devices are now also being used for telemedicine to make home visits and perform diagnosis of non-emergent medical disorders. Consumers are now storing their health information, list of medications and even the costs of treatment on smart-phones. With the smart-phones, consumers will be able to access their health records anywhere anytime. Smart-phones will also allow the ability to speak to a doctor and/or let the doctor see the patient remotely to deliver care from the doctor’s office to the patient’s location. Surveys indicate that the use of mobile devices for maintenance of medical health have doubled in just the past 2 years and many consumers will prefer to use their smart phones to connect to their healthcare provider in the coming year. The biggest question that remains to be seen is how patients and hospitals will manage security on these devices!

Data Security and patient privacy issues are always a concern. Because of the threat from hackers, almost every major medical device will need to have security features to prevent breaches that could cripple the industry. Consumers have already started to become weary of buying any new medical devices and hesitant to use what is available in hospitals because of recent hacking reports. Physician’s office and hospitals will have to step up and ensure there are no breaches in security. Otherwise, the penalties will be severe. More important, it can ruin the reputation of a hospital and lead to a decline in patients.

What are your top 3 focuses in 2016?

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