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BIDMC’s Internal EHR and A Possible Epic Future

Posted on February 11, 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.

One of the surprising reactions for me in the announcement of Athenahealth’s acquisition of Beth Israel Deaconess Medical Center’s (BIDMC) in house webOMR platform was by John Halamka. As I mention in the linked article, it really isn’t a pure software acquisition as much as it is Athenahealth going to school to learn about the inpatient EHR space. However, John Halamka’s reaction to this announcement is really interesting.

As I read through all of the coverage of the announcement, John Halamka seems to have shifted gears from their current in house EHR approach to now considering a switch to some other external EHR vendor. This is very interesting given this blog post by John Halamka back in 2013. Here’s an excerpt from it:

Beth Israel Deaconess builds and buys systems. I continue to believe that clinicians building core components of EHRs for clinicians using a cloud-hosted, thin client, mobile friendly, highly interoperable approach offers lower cost, faster innovation, and strategic advantage to BIDMC. We may be the last shop in healthcare building our own software and it’s one of those unique aspects of our culture that makes BIDMC so appealing.

The next few years will be interesting to watch. Will a competitor to Epic emerge with agile, cloud hosted, thin client features such as Athenahealth? Will Epic’s total cost of ownership become an issue for struggling hospitals? Will the fact that Epic uses Visual Basic and has been slow to adopt mobile and web-based approaches provide to be a liability?

Or alternatively, will BIDMC and Children’s hospital be the last academic medical centers in Eastern Massachusetts that have not replaced their entire application suite with Epic?

Based on John Halamka’s comments it seems that his belief might have changed or at least he’s considering the option that an in house system is not the right approach moving forward. No doubt Athenahealth is hoping that they’ll delay the decision a few years so they have a chance to compete for BIDMC’s business.

If you look at the rest of the blog post linked above, Halamka was making the case for Epic back in 2013. I think that clearly makes Epic the front runner for the BIDMC business at least from Halamka’s perspective. We’ll see how that plays out over time.

It seems like we’re nearing the end of the in house EHR hospital. Are there any others that still remain?

Will Cerner Let Mayo Clinic Move to Epic Easily?

Posted on February 9, 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 most regular readers know, we don’t try to get into the rat race of breaking news on things like EHR selection, the latest meaningful use, or whatever else might be time sensitive healthcare news. Sure, every once in a while we’ll report something we haven’t seen or heard other places, but we’re more interested in the macro trends and the broader insight of what various announcements mean. We don’t want to report on something happening, but instead want to tell you why something that happened is important.

A great example of this is Mayo Clinic’s decision to go with Epic and leave behind Cerner, GE, and other systems. There’s a good interview with Mayo Clinic CEO, Cris Ross, that talks about Mayo’s decision to go with Epic. As he says in the interview, GE Centricity wasn’t part of their future plans, and so they were really deciding between Epic and Cerner. Sad to see that Vista wasn’t even part of their consideration (at least it seems).

Based on Cris Ross’ comments, he commented that he liked Epic’s revenue cycle management and patient engagement options better than Cerner. Although, my guess is that they liked Epic’s ambulatory better than Cerner as well since they were going away from GE Centricity. Cris Ross’s double speak is interesting though:

As we looked at what met our needs, across all of our practices, around revenue cycle and our interests around patient engagement and so on, although it was a difficult choice, in the end it was a pretty clear choice that Epic was a better fit.

Either it was a difficult choice or it was a pretty clear choice. I think what Cris Ross is really saying is that they’d already decided to go with Epic and so it was a clear choice for them, but I better at least throw a dog bone to Cerner and say it was a hard choice. Reminds me of the judges on the voice that have to choose between two of their artists. You know the producers told them to make it sound like it’s a hard choice even if it’s an easy one.

Turns out in Mayo’s case they probably need to act like it was a really hard choice and be kind to Cerner. Mayo has been a Cerner customer for a long time and the last thing they want to do is to anger Cerner. Cerner still holds a lot of Mayo’s data that Mayo will want to get out of the Cerner system as part of the move to Epic.

I’ll be interested to watch this transition. Will Cerner be nice and let Mayo and their EHR data go easily? Same for GE Centricity. I’ve heard of hundreds of EHR switches and many of them have a really challenging time getting their data from their previous EHR vendor. Some choose to make it expensive. Others choose to not cooperate at all. Given Mayo’s stature and the switch from Pepsi to Coke (Cerner to Epic, but I’m not sure which is Pepsi and which is Coke), I’ll be interested to see if Cerner lets them go without any issues.

I can’t recall many moves between Epic and Cerner and vice versa. Although, we can be sure that this is a preview of coming attractions. It will be interesting to see how each company handles these types of switches. What they do now will likely lay the groundwork for future EHR switching.

Getting More Out of the EHR Than What You Put In

Posted on January 21, 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.

When I first met with Stoltenberg Consulting a few years back at CHIME, they said something really interesting that I’m still thinking about today. In fact, I might be thinking about this more today than I was doing before.

Per my notes (so I won’t make it a direct quote), they commented that doctors were putting a lot into the EHR, but they don’t feel like they’re getting a lot out of the EHR.

It’s a powerful idea that is really important for any hospital executive to understand.

I recently wrote about the choice between the Best-of-Breed EHR and the All-In-One EHR approaches on EMR and HIPAA. Here’s the money section:

The real decision these organizations are making is whether they want to put the burden on the IT staff (ie. supporting multiple EHRs) or whether they want to put the burden on the doctors (ie. using an EHR that doesn’t meet their needs). In large organizations, it seems that they’re making the decision to put the burden on the doctors as opposed to the IT staff. Although, I don’t think many organizations realize that this is the choice they’re making.

Choice of EHR is only one of the main reasons why doctors likely feel that they’re getting less out of the EHR than they’re putting into it. Certainly reimbursement requirements and meaningful use should still take a lot of the blame as well. Regardless of how we got here, it’s a very precarious position when the doctors feel like they’re getting less out of the EHR than they are putting into it.

There is a solution to this problem. First, you must work to maximize the physician workflow. Sometimes this means involving the nursing staff more. Sometimes this involves a scribe. Other times it requires a change to your EHR. Other times it means building out high quality templates that make the doctor more efficient.

Second, we must all focus on more ways doctors can get more value out of their EHR. The buzzword analytics has potential, but has been a little too much buzz word and not enough practical improvement for the doctor and patient. We need more advanced tools that leverage all the data a doctor’s putting in the EHR. Clinical Decision Support, Drug to Drug and Drug to Allergy checking are just the first steps. We can do so much more, but unfortunately we’ve been too distracted by government regulation to deal with them. Plus, let’s not kid around. These aren’t easy problems to solve. They take time and effort. Plus, we need a better way for doctors and hospitals to be able to diffuse their discoveries across the entire healthcare community. Sharing these discoveries is just too hard and too slow right now.
EHR Scale
At the end of the day, it’s a simple scale. On the one side you have the time and effort a doctor puts into the EHR. On the other side is the value the doctor gets from the EHR. You can solve this by making the doctor’s EHR work more efficient or by finding more ways the EHR can provide value to the doctor. Much easier said than done. However, if this stays out of balance too long, you can count on a big EHR backlash from doctors.

CIOs Want More Responsibility — And It’s About Time They Get It

Posted on January 19, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The life of a healthcare CIO is a tough one. More than ever before, healthcare CIOs walk a fine line between producing great technical results and thinking strategically about how technology serves clinicians. As with their more junior peers, many healthcare CIOs only get noticed when something breaks or goes offline. Worse, healthcare CIOs may get the blame dumped on them when a big project — especially a mission-critical one like an EMR implementation — fails due to problems beyond their control.

But despite the political battles they must fight, and the punishing demands they must meet, healthcare CIOs are largely satisfied with their career paths — as long as they have a shot at getting more responsibility that can help them move their organization’s strategy forward. This, at least, is the conclusion of a new survey by SSi-SEARCH.

SSi-SEARCH surveyed 169 CIOs to learn how they felt about key aspects of their job, according to iHealthBeat.  All told, the researchers found that CIOs are most satisfied with the trajectory of their career, compensation and strategic involvement. (This is a significant change from a couple of years ago, when CIOs told SSi-SEARCH that their pay wasn’t keeping up with the growth in their responsibilities.)

On the other hand, healthcare CIOs were markedly dissatisfied with the resources available to them, and almost half (48%) said that there will need to be changes within the next year. That’s certainly no surprise. As we’ve noted in this space before, not only do healthcare CIOs need to implement or further augment EMRs and handle the switch from ICD-9 to ICD-10, many need to make costly upgrades to or replace their revenue cycle management systems.

Even if their institution can’t increase their budget, healtlhcare CIOs would be somewhat mollified if they got some respect for some of the softer skills they bring to the table.

Forty-five percent of those surveyed said they wanted recognition for improving patient safety, 44 percent said they wanted to be recognized for innovation, and 37 percent wanted CEOs to appreciate their skill at “bringing departments together,”  SSi-SEARCH found.

Not surprisingly, they want to be appreciated for their overall contributions to their institutions as well. While 69 percent of CIOs felt that their work was “critically important” to the strategic mission of their organization, and 29 percent felt they had been “very important,” some of their employers don’t seem to see it. In fact, 23 percent of those CIOs surveyed felt that they hadn’t been recognized at all.

Sadly, though the healthcare CIO’s job has evolved far from bits and bytes to projects and strategies that directly impact outcomes, not every institution is ready to give them credit. But if they have CIOs pigeonholed as tech wizards, they’d better change their tune.

Giving CIOs the latitude, responsibility and budget they need to do a great job is enormously important. If healthcare organizations don’t, they’ll never meet the demands they currently face, much less emerging problems like population health management, big data and mobile health. This is a make-or-break moment in the dance between healthcare organizations and IT, and it’s not a good time for a misstep.

FHIR Adoption Needs Time to Mature

Posted on January 7, 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 John Halamka’s look at Health IT in 2014 he offered some really great insight into how regulators should look at standards and adoption of standards.

Here’s one section which talks about the lesson learned from meaningful use stage 2:

“Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.”

Then, he offers this money line about FHIR and how we should handle it:

“We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption”

There’s no doubt that FHIR is on Fire right now, but we need to be careful that it doesn’t just go down in flames. Throwing it into a regulatory program before it’s ready will just smother it and kill the progress that’s being made.

Healthcare Leadership Learnings from Niagara Falls

Posted on December 31, 2014 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.

Niagara Falls in Winter
As this picture shows, my wife and I recently got to spend some time alone (ie. no kids) at Niagara Falls. My wife comes from upstate NY and I proposed to my wife while at Niagara Falls. So, it’s a special place to us. As such, we’ve visited it many times. Plus, I just adore waterfalls.

As I was watching the waterfalls this time, I was again blown away by the volume of water that pours over the falls consistently, all day, every day and has for years. It’s extraordinary that it’s even possible, but the power of all that water is awe inspiring.

Thinking about this wonder of the world, I started to think about healthcare. At first I thought that those of us in healthcare IT were strapped at the bottom of the falls and couldn’t leave. The regulations kept coming over the falls and hammering us over and over. The regulations were unrelenting and we just had to try and find a way to survive. I imagine that many reading this could relate to that feeling. In fact, I bet many of you are tired of the regulations and ready to give up and float down the river.

As my mind continued to wander, I thought that the same was true when it comes to a team working consistently on a problem. A well organized team that keeps consistently hammering away at something over time is a powerful powerful force for good. Instead of being strapped to the waterfall, our teams could be the waterfall that’s hammering away over and over at the problems of healthcare.

Never underestimate the power of many people all working consistently to solve a problem. I’ve been part of teams like that and the results are amazing! Where do you find yourself? Are you at the bottom of the falls or are you the falls?

Hospitals Put Off RCM Upgrades Due To #ICD10, #MU Focus

Posted on December 29, 2014 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.

If you look closely at the financial news coming out of the hospital business lately, you’ll hear the anguished screams of revenue cycle managers whose infrastructure just isn’t up to the task of coping with collections in today’s world. Though members of the RCM department — and outside pundits — have done their best to draw attention to this issue, signs suggest that getting better systems put in has been a surprisingly tough sell. This is true despite a fair amount of evidence from recent hospital financial disasters that focusing on an EMR at the expense of revenue cycle management can be quite destructive.

And a new study underscores the point. According to a recent Black Book survey of chief financial officers, revenue cycle upgrades at U.S. hospitals have taken a backseat to meeting the looming October 2015 ICD-10 deadline, as well as capturing Meaningful Use incentives. Meanwhile, progress on upgrades to revenue cycle management platforms has been agonizingly slow.

According to the Black Book survey, two thirds of hospitals contacted by researchers in 2012 said that they plan to replace their existing revenue cycle management platform with a comprehensive solution. But when contacted this year, two-thirds of those hospitals still hadn’t done the upgrade. (One is forced to wonder whether these hospitals were foolish enough to think the upgrade wasn’t important, or simply too overextended to stick with their plans.)

Sadly, despite the risks associated with ignoring the RCM upgrade issue, a lot of small hospitals seem determined to do so. Fifty-one percent of under 250 bed hospitals are planning to delay RCM system improvements until after the ICD-10 deadline passes in 2015, Black Book found.

The CFOs surveyed by Black Book feel they’re running out of time to make RCM upgrades. In fact, 83% of the CFOs from hospitals with less than 250 beds expect their RCM platforms to become obsolete within two years if not replaced or upgraded, as they’re rightfully convinced that most payers will move to value-based reimbursement. And 95% of those worried about obsolescence said that failing to upgrade or replace the platform might cost them their jobs, reports Healthcare Finance News.

Unfortunately for both the hospitals and the CFOs, firing the messenger won’t solve the problem. By the time laggard hospitals make their RCM upgrades, they’re going to have a hard time catching up with the industry.

If they wait that long, it seems unlikely that these hospitals will have time to choose, test and implement RCM platform upgrades, much less implement new systems, much before early 2017, and even that may be an aggressive prediction. They risk going into a downward spiral in which they can’t afford to buy the RCM platform they really need because, well, the current RCM platform stinks. Not only that, the ones that are still engaged in mega dollar EMR implementations may not be able to afford to support those either.

Admittedly, it’s not as though hospitals can blithely ignore ICD-10 or Meaningful Use. But letting the revenue cycle management infrastructure go for so long seems like a recipe for disaster.

Will I See Any Hospital CIO’s at CES?

Posted on December 19, 2014 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.

For those not familiar with the International CES conference, it’s held in Las Vegas every year at the beginning of January. CES stands for consumer electronic show and it is a show that literally takes over the city of Las Vegas. It’s so full of tech and geek that they use the entire Las Vegas Convention Center, the entire Sands Convention Center, and all of the conference area of the Westgate (Previously LVH and the Hilton), and all of the conference area in the Aria, and at least a couple days at Mandalay Bay. Long story short, the event is massive! I bet some of the larger vendors spend upwards of a million dollars or more on their booths.

As part of the growth of the show, there’s been a larger and larger digital health section of the show. Plus, that doesn’t really include the massive companies like Samsung that have gotten into health as well but have an enormous booth in another area of the show.

The largest portion of health at CES carries the banner of the Digital Health Summit and mostly includes wearables (check out my previous post on Hospitals and Wearables) and robotics (often tied to Telemedicine). However, I know many technology people come to see where the tech is headed so they can prepare. That’s why I attend the event every year.

To be honest, I’ll be surprised if I see any hospital CIOs at CES. Possibly a few hospital CTOs who are looking at some technology, but that might even be a stretch. What it makes me wonder is where hospital IT executives search to see what’s happening next for technology. Where do you look for innovation and where technology that can benefit your hospital is heading?

More CDI and EHR Optimization Discussion

Posted on December 5, 2014 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 response to the question I posted in yesterday’s blog post, “What’s the Difference Between CDI Programs and EHR Optimization?“, Richard Tomlinson, Founder and CEO of Nuclei Health Consultancy offered this response that I thought would help continue the discussion and be interesting for readers:

In answer to your excellent question, no. CDI and EHR optimization are not the same; in fact the two models are significantly different, as are their goals.

Without deep dives here, the root decision tree to choose CDI over optimization should be based upon analysis results to the issues and goals identified. What are the identified issues? And what are the identified and measurable goals.

I will share that workflow analysis is one significant differentiator between CDI and Optimization. If one of the goals mentioned above for example is to reduce time documenting , or, a shift of role assignment in portions of workflows to reduce cost or improve provider thruput, then optimization here may include the addition of technology. Sounds counterintuitive, nevertheless the business model of optimization is indeed different.

Reducing clicks in clin doc has been cited as optimization, but I am here to tell you that alone is not the case. I would tend to take that stand alone as CDI, although one can argue reducing clicks does not “improve” clinical documentation.

As an overall, I would tend to say optimization is holistic in its foundation to include analysis of workflows, content build specifications, ROI of additional technology/tools, education, with the cumulative impact compared to a set of defined clinical and business goals. CDI by contrast may support only a goal as simplistic as rearrangement or placement of data to achieve a specific benefit.

I look forward to hearing other people’s thoughts on this subject.

What’s the Difference Between CDI Programs and EHR Optimization?

Posted on December 4, 2014 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 heard someone describe their EHR optimization as a Clinical Documentation Improvement (CDI) project. It made me start to wonder if CDI and EHR optimization were quickly becoming the same thing.

While some CDI programs require EHR optimization, not all CDI programs require it. Some EHR optimization can improve clinical documentation, but not all of them. However, there is a decent overlap between the two efforts.

There are a lot of ways a CDI program can improve your clinical documentation. As we start to see full adoption of EHR software, most of the CDI programs are going to focus on the way the visit is documented in the EHR. While the EHR use might be to blame in many cases, the most important part of any CDI effort is the people that use that program. In fact, it’s often not even about how they use the program, but just the choices they make.

What has become very valuable is that EHR’s have made CDI programs much more efficient. They can run the program remotely. They can run reports that focus on common clinical documentation errors and focus their program on those specific errors. Technology can really help a CDI program to focus on the pieces of the chart that matter most.

EHR optimization on the other hand could have nothing to do with improving the clinical documentation. It very well may be that the clinical documentation is perfect. In an EHR optimization, you may only be looking at how to improve the physician workflow while maintaining the high level of clinical documentation.

EHR optimization is a powerful thing and not enough organizations are doing it. I get that they’re too distracted by meaningful use, but if we’re going to really benefit from EHR software we need more organizations focused on optimizing their EHR use.

It will be interesting to see how hospital leadership handles the governance of CDI and EHR optimization programs. They are both going to be very important going forward.