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Virtualization, Speech Recognition App Use Growing Among Hospitals

Posted on October 21, 2013 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.

Virtualization software and dictation with speech recognition are likely to see increased uptake among hospitals in coming years, according to data from HIMSS Analytics.

The data, which is drawn from its Essentials of the U.S. Hospital Market, Autumn 2013 report, suggests that virtualization and dictation with speech recognition are top areas for growth potential, ahead of most other apps profiled in the report.

According to a HIMSS statement, these findings are consistent with other research the organization has done in the past which has suggested growing adoption of voice recognition-based transcription technologies.

The HIMSS report also concludes that demand for ambulatory EMRs and ambulatory PACS seems to be growing, according to the press release.

My colleague John Lynn and I had a huddle to discuss these results and while I see the growth in demand for voice recognition, he’s a bit more skeptical.  In  his view, voice recognition hasn’t changed much over the last couple of years, so it’s not clear to him whey there’d be an upsurge in demand now. Did Siri-like technologies make us more comfortable with voice recognition?

The only exception to this, he suggested, may be some integration deals that Nuance did with Cerner and Epic that might cause an increase in voice recognition adoption. However, this will only be mostly those who wanted voice recognition already as opposed to converting new people to voice recognition.

On my end, I’m a bit more bullish on voice recognition technology, at least if EMRs are capable of parsing the narrative into fields in the EMR.  I’m aware of some EMR vendors and some independent software vendors that are doing this or headed in that direction.

As for virtualization, John is a bit more excited about the future. After all, as he notes, there’s some cost savings and redundancy, plus fail over, that are nice benefits of virtualization. He’s also a fan of its disaster recovery and business continuity capabilities, in that if one server dies, you can roll a whole virtual machine over to another seamlessly.

As for me, I’d argue that any technical trend you see here could be changed abruptly as the EMR market shifts. Let’s see how the next Meaningful Use phase, and the further consolidation of the EMR sector, affects what’s hot and what’s not.

Buy EHR vs Build EHR

Posted on October 14, 2013 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’ve long had an interest in the topic of when hospitals chose to buy their EHR software versus build their EHR software. In fact, we’ve written multiple times on the subject including Anne Zieger’s piece on “Some Hospitals Still Choosing To Build Own EMR“.

With this as background, I was really intrigued by Dr. Edmund Billings’ blog post looking at how open source EHR is the best of both buy and build worlds. Here’s a good section of his article which frames the debate:

In a Buy vs. Build decision, the key drivers are control and cost. Do you have control over your system at a cost you can afford? The decision calculus then shifts to ownership on two levels: First, can we have true ownership of our solution and make it work ourselves? Second, is the total cost of ownership economically sustainable?

Dr. Billings then goes on to make the case that open source EHR is the best of both worlds. He compares the open source EHR vista to Linux and Red Hat to Medsphere. It’s a pretty app comparison of what Medsphere is trying to do. Dr. Billings does point out that an enterprise EHR is not an operating system (like RedHat/Linux). Although, I find that ironic since I’ve written before about how I think that the EHR is the operating system of healthcare.

One major difference between Linux and VistA is how they’re implemented. Linux could be implemented by an organization on just a server or two while still running all the old servers on something else. Then, over time they could add in more Linux servers. This isn’t the case with VistA. Everyone wants an Enterprise EHR to be implemented across the entire system. I don’t see someone implementing VistA in one department and then growing from there. Maybe we should do it this way, but that’s not what I see happening in the market. They buy an EHR system they can use across their whole organization.

This difference aside, open source does provide an interesting balance between the buy vs build mentality. I wonder why hospital organizations have chosen other EHR vendors over the open source EHR alternatives.

Should Hospital Associations Choose EMRs?

Posted on October 10, 2013 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.

Today I read a press release trumpeting the new relationship between the Texas Hospital Association and Enterasys Networks, which is now the THA’s preferred provider for wired and wireless network infrastructure products.

When I read this I found myself thinking “wow, is it really that easy?” Will hospitals rely on intermediaries like the THA to do the due diligence and sort out what sort of networking gear they should buy?

To me, this is an intriguing concept which could easily and logically extend to EMRs. After all, state hospital associations could do an analysis of an EMR’s technical strength, usability, interoperability and features as well as a  health system or hospital could.

It would certainly upend the industry if hospital associations routinely got down and dirty with EMRs, went through a selection process and put their “recommended” stamp on a small handful of systems.

If nothing else, it would be a shock to vendors, who would have to create new channel relationships with the associations, quickly and well. Marketing to associations wouldn’t superceded marketing to individual hospitals completely, but it would add a new layer of effort.

It would also give some attention to lesser-known EMR vendors. I’d argue that in an honest process, it’s unlikely that all — or even most — of the hospital associations would only choose as “winners” the enterprise EMRs that dominate the market today.  This is not to say that giants like Epic and Cerner would never be selected; it’s just that as I imagine it, a thorough hospital association selection process would identify some underdogs that deserve hospitals’ business.

The truth is, though, that most hospital associations wouldn’t want to go down the road of officially putting their stamp of approval on a small collection of EMRs. The task is enormous, the political costs high if members don’t agree with their choices, and the downside is considerable if a recommended vendor completely flames out in some way.

No,  it seems to me that while the THA has put its credibility on the line for Enterasys, I don’t see it (or its peers in other states) sticking an oar in the EMR selection business. There’s just too much at stake. They’ll spend their last penny fighting regulatory battles — particularly as Meaningful Use steams along — but hospital trade groups are not going to become the EMR Fairy.

Leveraging Vendor Neutral Archives Against EHR Vendor Lock In

Posted on October 3, 2013 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 of a new strategy that some organizations are employing to be able to avoid EHR vendor lock in. I’m happy to support anything that prevents EHR vendor lock in. The fact that a hospital can switch EHR software, doesn’t mean they will. However, the ability to switch EHR software usually means that the EHR vendor makes more effort to make sure they’re meeting the customer’s needs. This is why I think that preventing EHR lock in is so important. I don’t like EHR vendors resting on their laurels because a hospital has no choice but to use that software.

The method I heard described was a hospital who chose to implement a vendor neutral archive (VNA) of their EHR data. We usually hear VNA’s applied to radiology, but I predict over the next 3-5 years every large organization will have an EMR VNA as well. In this case, the hospital chose to implement a VNA while they were on good terms with their current EHR vendor.

Most EHR vendors won’t facilitate a VNA if you’re leaving them. So, it’s important that this is done before you choose to leave an EHR vendor. We also shouldn’t start assuming now that everyone that has a VNA is getting ready to part ways with their EHR vendor. In fact, I’d love for an EHR VNA to become the standard in the industry. That way, if and when an organization chooses to change software vendors, they can do so without losing all of the important data they’ve been collecting and storing in their EHR.

Just remember that it’s too late to employ this strategy when you’re ready to switch EHRs. It takes a forward thinking organization and investment to do this while everything is going great with your EHR vendor. Consider the investment insurance for a rainy day to come. I assure you that day will come for most healthcare organizations.

Cerner, Intermountain Form Major Development Partnership

Posted on October 1, 2013 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.

Normally, when I read the news of a vendor partnership, it’s a major snoozefest. After all, marketing deals and customer wins may be important to the vendor, but they don’t change our life much.

This time, though, I’m willing to go out a limb and say that the following is an important deal. Cerner, one of the leading players on the enterprise EMR front, has struck an agreement with healthcare chain Intermountain Healthcare under which the two will partner long-term on activity-based costing.

Intermountain, the largest health provider in the Intermountain West region of the US, is making a huge Cerner buy, Information Week reports. As part of its agreement with Cerner, Intermountain is tearing out its existing systems, including two EMRs, two billing systems and desktop integration system, and replacing them with Cerner technology.

In this deal, you can certainly chalk up one more win for Cerner, which has been gaining ground in the 200+ bed hospital segment of late. According to KLAS, the ratio of Epic-to-Cerner wins has fallen from 5-to-1 in 2010 to 2-to-1 in 2012 in this segment, according to the research firm.

But the agreement goes well beyond being a mere sale. Once the new, integrated Cerner system is in place, it will serve as the foundation for the long-term project partners have in mind.

Intermountain chose to partner with Cerner because of its system’s open architecture, which will allow for the addition of new content Intermountain plans to provide, CIO Marc Probst told Information Week.

The partners plan a closely-integrated relationship which involves the movement of several Cerner executives and staffers to Intermountain’s headquarters in Salt Lake City. Their work will include development of care process models, connectivity-based costing, advanced decision support and clinical workflows, IW reports.

Getting this work done requires little short of a wedding. ” “We’re looking at 20 plus years of collaboration. We have shared interests in making this be a great success,” Probst told the magazine.

EHRs Can Generate Meaningful Return On Investment

Posted on September 27, 2013 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.

Well-implemented EMRs can certainly generate Meaningful Use incentive payoffs, but that’s far from the only way that they can help a practice generate return on their EHR investment.

According to “Return on Investment in EHRs,” a whitepaper sponsored by GBS, HP, Intel and Nextgen, properly implemented EHRs can do a great deal to generate ROI for medical practice above and beyond qualifying them for MU payoffs.

The paper notes that many practices have achieved a return on investment in their EHRs without receiving external incentives. As it points out, a Health Affairs study from 2005 found that while initial EHR costs averaged $44,000 per full-time equivalent, and ongoing costs averaged $8,500 per provider per year, the average practice paid for EHR costs in 2.5 years and generated a profit after that.

Eleven of the 14 practices studied by Health Affairs had “tightly integrated” EHR and practice management systems, a factor the paper contends was highly relevant to their success with their EHR implementation. Not only did providers use the EHR for common tasks, almost all used it to help with billing. Ten of the practices no longer pull paper charts at all, the study noted.

EHRs also improve efficiency and productivity in the following ways, the paper argues:

* More appropriate coding: Properly-designed EHRs help physicians with coding by displaying the appropriate code based on the documentation entered during a patient encounter. This avoids costly undercoding.

* Greater efficiency: The use of point-and-click templates lessens and in some cases eliminates transcription costs, which can be up to 11 percent of collections.

* Reduction in soft costs: Fully-enabled EHRs also remove many “soft costs” that practices occur, such as the time it takes to call in prescriptions. Also, once doctors learn how to use the EHR, they can complete most of the notes during or between patient visits, leaving them with time to either see more patients or go home earlier.

It’s great to think that medical practices can generate ROI on their EHR investment, but given that the sponsors of this paper have their own agenda, I’m not taking everything they say at face value. What do you think, readers? Have you seen situations in which practice EHRs generate significant ROI independently of what they take in in Meaningful Use dollars?

Stanford Uses Epic Feature To Conduct Web Visits

Posted on September 20, 2013 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.

Stanford Hospital & Clinics has rolled out a new primary care service, powered by a feature available within its Epic EMR, offering medical visits via web video.

The new service allows patients to schedule video visits via the hospital website, using a scheduling application available on the site, InformationWeek reports. At the scheduled time, patient and doctor meet together in a web-based video conference.

The service, which Stanford dubs “eCare,” takes advantage of Epic’s software for video consultations. The video consult is integrated into the patient’s Epic medical record automatically. eCare also integrates third–party identity verification services in an effort to make sure the patient is who they say they are.

According to Stanford CIO Pravene Nath, M.D., who spoke with InformationWeek, video visits are medically appropriate for a range of noncritical visits and follow-ups. For example, one of the service’s first patients had an eye condition; the doctor was able to help simply by looking into the camera at the patient’s eyes. Another example of condition appropriate for web conferencing is treatment of a skin rash, Nath said.

“These are cases where a quick visual is all that is needed, followed by a quick interaction of the patient talking with the doctor,” Nath told InformationWeek.

Stanford is offering eCare first to employees of self insured firms who contract with the hospital. That way, neither the employer nor Stanford has to worry about whether a managed-care company will reimburse the doctors for the video visits. But Stanford’s intent is to make video consults available to everyone, InformationWeek says.

Stanford’s care program is just one of several virtual healthcare services the hospital’s developing, IW reports. The organization is also looking into secure messaging between doctors and patients and a service which involves submitting a still photo of them conducting a live videoconference, the magazine says.

If Stanford can make the integrated EMR and web visits work, it may be breaking new ground. A few months ago, I wrote a piece noting that many telemedicine providers are very reluctant to integrate with EMRs, given that the need for interoperability with so many systems could choke their development efforts.

While enabling telemedicine isn’t going to offer Epic any huge advantage it doesn’t have already, it does offer some intriguing possibilities. If thought leaders like Stanford make a success of web visits, using Epic technology, it might force other competitors into the telemedicine arena as well. It will be interesting to see how influential Stanford’s experiment turns out to be.

Judy Faulkner Interoperability Chart

Posted on September 18, 2013 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.

Farzad Mostashari shared the following tweet which includes a picture of the growth in standards-based exchange per Judy Faulkner.

Here’s a blown up version of the chart (click on the image for an even larger version):
Epic Data Sharing Chart

As Farzad notes in the tweet, the patient records exchanged per month is now up to 1.25 million. It’s also worth noting that the red bar in the chart is exchange of records from Epic to Epic. The Green bar in the charts is from Epic to Non-Epic. I hope that green bar continues to grow since as the chart displays, that’s a definite shift in strategy for Epic. Let’s hope this shift continues until the data in healthcare is available where it’s needed when it’s needed.

Ohio HIE Hits 101-Hospital Mark

Posted on September 12, 2013 I Written By

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

This is a very busy time for HIE builders.  In recent months several states have either announced that they’d completed their preparations for a broad-based HIE or reached a new milestone in HIE participation.

For example, earlier this month the state of Wisconsin announced that it is gearing up to kick off a statewide HIE network that would embrace hospitals, clinics, nursing homes and other care facilities, powered by HIE technology vendor Medicity.

According to Health Affairs, this is part of a larger trend. A recent piece in the journal noted that health data exchanges between hospitals and other healthcare providers have climbed 41 percent between 2008 and 2012.

The latest in state HIE news comes from Ohio, where the state’s HIE has just announced that it had signed two hospitals, 25 bed Harrison Community Hospital in Cadiz as well as 91-bed Wilson Memorial Hospital in Sidney, reports Healthcare IT News.  With the new additions, Ohio’s CliniSync HIE now boasts 101 of the state’s hospitals.

CliniSync, which is run by the nonprofit Ohio Health Information Partnership, is based on Medicity technology as well.  With these new members, and the momentum it has underway, CliniSync might well be one of the largest public HIEs in the U.S. by 2014, Healthcare IT News reports.

According to Healthcare IT News, CliniSync makes it possible for physicians, hospitals, nurses and others who do patient care to share patient data electronically. What’s really neat, if true, is that CliniSync will allow doctors and hospitals with varied EMRs to share data. Previously, the HIE members could only share data regionally or within their own systems.

Epic Rollout Contributes To $55M Loss At NC Hospital

Posted on September 10, 2013 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.

It’s no secret that rolling out an Epic EMR is a big-ticket investment. What’s also becoming apparent is that some of the hospitals that take the plunge can’t really afford to pay for what they’ve bought, much less staff and develop an Epic presence.

The latest Epic EMR financial casualty to cross my desk is Wake Forest Baptist Medical Center which, according to the Winston-Salem Journal, saw a $55.1 million operational loss partly due its Epic rollout during fiscal 2012-13.

In a regulatory filing directed to bond investors, Wake Forest Baptist said that the Epic implementation had a substantial negative impact on fiscal 2013 due to both direct implementation costs and associated indirect expenses, according to the Winston-Salem Journal.

While the hospital’s stock investment gains of about $54 million helped offset most of the operational loss, leaving the overall loss at a much smaller $571,000, this fiscal year’s performance is still much worse than the previous year, when Wake Forest had $45.8 million in operational revenue and overall excess revenue of $88.7 million, the newspaper reports.

But the direct expenses and development costs weren’t the real capper, the newspaper said. The biggest Epic-related blow to Wake Forest Baptist came from $53.7 million in indirect impact, including $36.9 million of lost margin due to volume disruptions during the initial go-live and post go-live optimization. On top of that, the hospital reported $16.8 million in other Epic-related implementation expenses.

And that led to a shakeup in the C-suite. Giving the lie to the notion that nobody ever got in trouble for buying Epic, earlier this year, the hospital’s chief information officer of Wake Forest Baptist resigned in the middle of the troubled Epic launch.

In the article, the newspaper reports that Wake Forest Baptist “remains confident in Epic’s long-term benefit to the center”, and that hospital CEO Dr. John McConnell believes that the install “was absolutely necessary for patient safety,” he told the Winston-Salem Journal .

While it may turn out to be true that Wake Forest Baptist will be able to improve patient safety using its Epic EMR, in the mean time it’s having cut back on staff to pay for that gain. According to the newspaper, the center had planned to eliminate at least 950 jobs during the recent fiscal year;  some were not eliminated but may be during this fiscal year.