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NYC Hospitals Face Massive Problems With Epic Install

Posted on August 24, 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.

A municipal hospital system’s Epic EMR install has gone dramatically south over the past two years, with four top officials being forced out and a budget which has more than doubled.

In early 2013, New York City-based Health and Hospitals Corp. announced that it had signed a $302 million EMR contract with Epic. The system said that it planned to implement the Epic EMR at 11 HHC hospitals, four long term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.

The 15-year contract, which was set to be covered by federal funding, was supposed to cover everything from soup to nuts, including software and database licenses, professional services, testing and technical training, software maintenance, and database support and upgrades.

Fast forward to the present, and the project has plunged into crisis. The budget has expanded to $764 million, and HHC’s CTO, CIO, the CIO’s interim deputy and the project’s head of training have been given the axe amidst charges of improper billing. Seven consultants — earning between $150 and $185 an hour — have also been kicked off of the payroll.

With HHC missing so many top leaders, the system has brought in a consulting firm to stabilize the Epic effort. Washington, DC-based Clinovations, which brought in an interim CMIO, CIO and other top managers to HHC, now has a $4 million, 15-month contract to provide project management.

The Epic launch date for the first two hospitals in the network was originally set for November 2014 but has been moved up to April 2016, according to the New York PostHHC leaders say that the full Epic launch should take place in 2018 if all now goes as planned. The final price tag for the system could end up being as high as $1.4 billion, the newspaper reports.

So how did the massive Epic install effort go astray? According to an audit by the city’s Technology Development Corp., the project has been horribly mismanaged. “At one point, there were 14 project managers — but there was no leadership,” the audit report said.

The HHC consultants didn’t help much either, according to an employee who spoke to the Post. The employee said that the consultants racked up travel, hotels and other expenses to train their own employees before they began training HHC staff.

HHC is now telling the public that things will be much better going forward. Spokeswoman Ana Marengo said that the chain has adopted a new oversight and governance structure that will prevent the implementation from falling apart again.”We terminated consultants, appointed new leadership, and adopted new timekeeping tools that will help strengthen the management of this project,” Marengo told the newspaper.

What I’d like to know is just what items in the budget expanded so much that a $300-odd million all-in contract turned into a $1B+ debacle. While nobody in the Post articles has suggested that Epic is at fault in any of this, it seems to me that it’s worth investigating whether the vendor managed to jack up its fees beyond the scope of the initial agreement. For example, if HHC was forced to pay for more Epic support than it had originally expected it wouldn’t come cheap. Then again, maybe the extra costs mostly come from paying for people with Epic experience. Epic has driven up the price of these people by not opening up the Epic certification opportunities.

On the surface, though, this appears to be a high-profile example of a very challenging IT project that went bad in a hurry. And the fact that city politics are part of the mix can’t have been helpful. What happened to HHC could conceivably happen to private health systems, but the massive budget overrun and billing questions have government stamped all over them. Regardless, for New York City patients’ sake I hope HHC gets the implementation right from here on in.

Finding New People on Healthcare Social Media and The Power of Showing Gratitude

Posted on July 13, 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 know that many in healthcare aren’t sure how to get started with social media. The reality is that Twitter is not very fun until you’re following 50-100 smart people that share interesting content, tweets, images, and videos. Once you do that, your entire Twitter experience changes because it’s a great font of learning and connection.

In case you don’t read one of my other blogs, EMR and HIPAA (and if you don’t why don’t you?), we recently announced the #HIT99. For those that don’t want to click into the post, you can basically include the hashtag #HIT99 in a tweet along with someone you want to nominate for the #HIT99 and why you’re nominating them. You can see that a lot of #HIT99 nominations have occurred.

For those of you new to social media, following people nominated to the #HIT99 is a great way for you to discover smart, interesting people in healthcare IT. Follow 50-100 people nominated and you’ll start to love Twitter and all you learn on it. The #HIT99 is a smorgasborg of social media discovery and connection. Finding new, interesting people to follow is always a treat. The #HIT99 provides the perfect opportunity to find and connect with new people you’d have never “met” otherwise.

Of course, if you’re already on social media, there’s a lot more to the #HIT99 if you participate. The #HIT99 asks that you mention why you’re nominating someone. These displays of gratitude are powerful for you and the person receiving it. Even if you don’t want to participate in the #HIT99, think about doing something similar using whatever medium you prefer. It’s a powerful idea that will reap major rewards for everyone involved.

I look forward to many in the Hospital EMR and EHR community participating in the #HIT99. In case you need an example, here’s a nomination that I sent (and is a great person to follow):

Let’s let the social media connection and gratitude flow! We can use more of that in this world.

Hiring Motivated People and Inspiring Them

Posted on July 8, 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 found this great leadership quote on LinkedIn that was shared by Shanthi Iyer:
Leadership Quote

This is some really great advice to hospital CIOs as they approach hiring at their hospital or health system. Hiring motivated people and inspiring them is a great way to lead an organization. You’d think that inspiring people in healthcare wouldn’t be hard. However, it’s amazing how quickly people can become disillusioned with what’s happening in healthcare IT. Government regulations aren’t usually inspiring.

With that said, all of us in healthcare should be inspired by the possibility that we can save lives. I know that many doctors scoff at the idea that a technology person could have that kind of impact, but we absolutely can. No, we don’t get our hands bloody as we stitch up a patient after surgery. However, we can create systems that make the doctors better and prevent mistakes that would happen otherwise.

Of course, if we’re going to take on the opportunity to save lives we have to also take on the responsibility that if we do our job poorly we can actually damage lives. Both sides of the coin are equally important. Certainly that’s inspiration enough for everyone in healthcare. However, a great leader finds ways to casually remind staff of this vision. That’s the challenge a healthcare CIO faces. Luckily, if you hire motivated people and inspire them, you’ll be amazed by the results.

RAC Audits Infographic

Posted on July 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.

RAC audits have quickly become a reality in every hospital system. Plus, the costs of managing these audits is increasing for many hospitals. HealthPort has put out this RAC Audits Infographic that highlights some of the trends with RAC audits.

The Year of Audits Infographic.Rev1.6.11.15

Needless to say, managing these RAC audits effectively is going to be extremely important to a health system going forward. From the AHA RACTrac survey which was the source for the infographic it says that “53% of all hospitals reported spending more than $10,000 managing the RAC process during the 4th quarter of 2014, 32% spent more than $25,000 and 8% spent over $100,000.”

What’s even more interesting is that HealthPort notes that many of the other payers are starting to make similar audit requests to measure the acuity of new patients entering the health system thanks to Obamacare (ACA). As this increases, the financial implications continue to increase as well.

What are you doing to make sure your RAC audits and other similar audits are managed effectively?

How Much Time Do You Spend Cleaning Your Data?

Posted on June 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.

I recently came across this really great blog post talking about data scientists wasting their time. Here’s a quote from the article (which quotes the NYT):

“Data scientists, according to interviews and expert estimates, spend 50 percent to 80 percent of their time mired in [the] mundane labor of collecting and preparing unruly digital data, before it can be explored for useful nuggets.”
– Steve Lohr, NYT

Then, they have this extraordinary quote from Monica Rogati, VP for Data Science at Jawbone:

“Data scientists are forced to act more like data janitors than actual scientists.”

Every data scientist will tell you this is a problem. They spend far too much time cleaning up the data and they all wish they could spend more time actually looking at the data to find insights. I’ve seen this all over health care. In fact, I’d say we have more data janitors than data scientists in healthcare. Sadly, many healthcare data projects clean up the data and then don’t have any budget left to actually do something with the data.

The solution to this problem is easy to write and much harder to do. The solution is to create an expectation and a culture of clean data in your organization.

I predict that over the next 5-10 years, healthcare data is going to become the backbone of healthcare data decision making. Those organizations that houses are a mess are going to be torn down and sold off to the hospital that’s kept a clean house. Is your hospital data clean or dirty?

Lessons To Consider When Weathering M&A Transitions

Posted on June 24, 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.

These days, the need for sophisticated IT infrastructure and the shift to risk-bearing insurance contracts are increasingly favoring large, muscular players. Not surprisingly, healthcare industry M&A is reaching a new peak.  Just about any substantial healthcare organization is facing the question of whether to acquire outside players and bulk up, merge with a bigger healthcare player or risk going it alone.

Particularly if you’re doing the acquiring, however, achieving critical mass is just the first in a long, difficult series of steps necessary to success. Health systems, in particular, face difficult management challenges when they try to integrate all of the moving parts necessary to survive as a next-gen organization.

A new study commissioned by West Monroe Partners, however, may shed some light on how to think about M&A integration issues. The study, which focuses on mid-market deals (between $300M and $2B) looks at post-merger integration across several industries, but I’d argue that its lessons still make sense for hospitals. Their tips for managing post-merger transitions include the following:

  • Start planning early:  West Monroe researchers found that companies which considered integration strategies as they began targeting and negotiating with merger partners were more successful in integration. Specifically, these companies were able to integrate more deeply than firms that didn’t began planning till pre-merger preparations were already under way.
  • Pay close attention to cultures: Here’s an eye-opening stat: more than half of companies surveyed by researchers said that merger value was lost due to lack of attention to differences in corporate cultures. Clearly, giving lip service to this issue but failing to address it intelligently can be costly.
  • Poor change management impacts future dealmaking:  In a clear case of “sadder but wiser,” a whopping 94% of survey respondents said that they would place more emphasis on change management next time they managed post-merger integration efforts. The study doesn’t spell out why but it seems likely that their past efforts blew up on them. Given that many health systems won’t stop at one deal in this climate, this is an important point.
  • Communicating change well is essential: About three-quarters of mid-market execs said that communicating change to their staff was one of the hardest parts of integration, and 62% said that communicating to outsiders was a major challenge. Many seem unhappy with the results of the past efforts, as 57% said this was a key area for improvement.

Some of these suggestions may be discouraging for hospital leaders. After all, required and important changes like the ICD-10 transition and ongoing EMR changes may already have staffers near burnout, and they may react badly to coping with added cultural changes.

That being said, the survey results also suggest that many of the integration challenges healthcare organizations face can be headed off somewhat by smart planning.  At least there’s something execs can do to cushion the blow.

The Next Big Healthcare IT Brands

Posted on June 22, 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 it, I wrote a post on EMR and HIPAA that talks about how patients will choose healthcare. In the article we talk about the impact of brand on healthcare decision making. Plus, I talk a bit about how many real national healthcare brands there are in the industry.

With this in mind, I was struck by this tweet from @theEHRGuy:

As the post above illustrates, I’d considered the impact of brand on healthcare decision making by patients. I hadn’t thought about the power of brand for healthcare IT companies. Over the past couple of years, we’ve definitely seen how important brand has been as many hospitals have chosen to buy from the brand as opposed to taking a best of breed approach to their IT systems. This has been an extremely important trend in healthcare IT.

In my recent post, I also talked about the move away from Best of Breed EHR systems and how that could apply to patient engagement solutions as well. I think this cycle is inevitable and I think patient engagement could be an area where a big brand establishes their name in the industry. Especially because the incumbent EHRs aren’t competing well in the patient engagement space.

I’ve also written about how I think that the Care Management System could be the next system purchase now that we’ve done HIS/PM and EHR. Could someone or a group of companies build a great brand for Care Management Systems? Could they build momentum around the need for every hospital to invest in some sort of Care Management System the way there’s been momentum for hospitals to adopt EHR?

Back to the tweet embedded above, I think it’s pretty interesting to think about the next big healthcare IT brands. Which brands do you think are going to be the next big ones? Every hospital CIO should be spending some time thinking about and watching these trends.

Healthcare IT Jobs – The Move from Consultant to FTE

Posted on June 19, 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 hospital IT we’re seeing a lot of changes happening with how a hospital IT department staffs itself. The past couple years, most hospitals have been busy implementing their EHR. This required them to hire a lot of EHR consulting companies that could scale up their manpower requirements for the implementation. In fact, many of these so called EHR consulting companies were actually just staff augmentation companies dressed as consultants. I even noted that the Healthcare IT Industry was addicted to consultants.

I think over the last 6 or so months, we’ve seen a move away from hiring as many consultants (we still love a good consultant) towards hiring more FTEs in hospital IT. This makes sense. As the EHR product has matured, the manpower needs are more stable and so it makes a lot of sense to hire a full time person to manage the ongoing needs.

We’ve seen that first hand on our healthcare IT job board. There are still some lingering consulting positions that are needed for the remaining EHR implementations, but hospitals are hiring more FTEs. I think this trend will continue for a good while to come.

In fact, we’re seeing a shift in consulting. Many EHR consulting companies are turning into EHR help desks. Others are going after value based reimbursement and healthcare analytics. In some cases, the consulting companies are turning into product companies. In other cases, they’re finally starting to consult.

Best of Breed in Patient Engagement?

Posted on June 17, 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 I’ve been thinking more about the future of healthcare IT, I wrote that I think the next major healthcare IT product could be a Care Management System. Maybe it will go by a different name, but the functionality that’s described by a care management system is already going into place. Regulations are headed that direction and every organization will need to have a care management system.

At the core of a care management system will be functionality that engages the patient. I use that term in the broadest sense possible and not the fully corrupted meaningful use version of patient engagement. I’m talking about truly engaging the patient in their care in a bi-directional way that includes communication, support, education, social influence, and more.

As I consider the broad possibilities around patient engagement, there are hundreds of companies (possibly thousands) working in this space. Some are working with diabetic patients while others are focused on cardiac issues. Others are using text messages while some startups are leveraging full smart phone applications. A few tie in with the EHR vendors and many don’t. A hospital system is going to need a patient engagement solution that cuts across all of these slices.

With that in mind, it begs the question, “Are we going to implement and manage a cobbled together “best of breed” solution for patient engagement?

If EHR history tells us anything, most hospitals will adopt some point patient engagement solutions and then over time they’ll realize that the best of breed approach to patient engagement has gotten unwieldy and they’ll start looking for an all in one patient engagement solution. In some ways, this has to be the path forward. There’s no all in one patient engagement solution today. So, hospital systems have to choose to either sit on the sideline and wait for the all in one system to arrive (like many did with EHR software) or they have to go best of breed to start while the all in one patient engagement solutions come together.

I’m not sure this path is such a bad thing. It’s good for a health system to understand patient engagement in a smaller way before expanding across the entire system. We’re starting to see more of this happen in hospitals. However, be sure to keep your eye on the long game being one unified patient engagement system.

We’re Entering the 15th Year of Our EHR Implementation

Posted on June 12, 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 was recently talking to someone about a major progressive hospital system that’s been using technology and EHR for a long time. This person then told me that it felt like this hospital system was in its 15th year of its EHR implementation.

I’m sure that most hospital organizations can relate to this statement. Each hospital system will replace the number of years with a different number, but I think every hospital probably believes that their EHR implementation is never complete. Certainly you might have a go live event with the initial installation of the software, but that’s far from a fully implemented EHR system.

This concept reminds me of two things we’ve talked about before. The first is a controversial post I did called The Tyranny of “Time” – EHR Efficiency Has a Lifecycle. I put up a chart which I think illustrates an important lesson about the lifecycle of an EHR implementation and many disagreed with the chart. I still stand behind the principle that time has a way of eroding even the best EHR implementation. So, you better have a long term plan to deal with the Tyranny of Time.

The second is a comment from a hospital CIO who made a comment on one of my posts many years ago. In the post I’d commented about how we’d implemented a new practice EHR in about 2 weeks time frame. The doctor was opening his practice in 2 weeks and so we literally crunched in the entire EHR implementation and purchasing process into those 2 weeks so they didn’t have to start on paper charts. The Hospital CIO’s comment on that article was “You lost me at 2 weeks EHR implementation.” Of course, this was an EHR implementation at a solo practice.

Although, even in the case of a small ambulatory practice, the EHR implementation is never done. At hospitals there’s always more that can be done to improve how you use your EHR. I don’t think it’s a bad thing to think that you’re in your XX year of your EHR implementation. As long as you still create milestones so that staff feel the sense of accomplishment in the process.