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Feds Plan EMR Certification For Specialty Facilities

Federal HIT leaders are planning to set up a voluntary program for testing and certification of EMRs used by behavioral health, long-term care and post-acute care, according to a story in Modern Healthcare. 

As things currently stand, they’re off the hook, as ARRA doesn’t require long-term or behavioral health facilities to buy certified EMRs.

These plans came to light last week at a webinar held by outgoing ONC head Farzad Mostashari, who said that his office is working on what the scope of such a program should be, MH reports. The webinar was held to discuss government officials’ reaction to public comments on how to improve interoperability.

In its original request for input, federal regulators noted that 4 in 10 hospitals were sending lab and radiology information to outside providers, though only one in four were  exchanging medication lists and clinical summaries, Modern Healthcare said.

Meanwhile, only 6 percent of long-term acute-care hospitals, 4 percent of rehab hospitals and 2 percent of psychiatric hospitals had even a basic EMR, the feds reported.

Launching these specialty-focused options seems like a logical next step for the certification program, and a long-delayed one at that. EMR certification has been a fact of life for several years, since then-ONC chief David Brailer kicked off the formation of the CCHIT.

Over the long haul, however, such new certification options may not be worth much unless they’re better matched to provider needs. My colleague John, for one, thinks the certification will have to change to actually offer value to doctors and healthcare organizations.

What do you think, readers?  Do you think certification programs for EMRs are a waste of time, or do you see them doing anything meaningful to improve care?

August 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

How Easy Are Hospitals Hacked?

This is an interesting tweet. I find it interesting that a hospital is working with local hackers. I guess it’s even more interesting that an EMR vendor has enough clout to be able to get a local hospital to not install software. Although, knowing the industry like I do, it’s not that surprising. Should a hospital listen to some local hackers or someone they’ve invested hundreds of millions and sometimes billions of dollars in? (yes, an EHR purchase is an investment)

Of course, this tweet reminded me of a great story my best friend in college told me about when he hacked into the major hospital system where he went to high school. Turns out he used a mix of physical and technical hacks to breach the hospital system.

The key to him breaching the hospital system was that he got access to a computer on the hospital system and left a back door for him to access that computer remotely. All he did to do this was put on a jacket, went to an office in the network where he said he was working for their IT department and was there to run some updates on the computer. They happily let him run the “update” on their computer. Instead, he created a back door where he could get access to the hospital network from anywhere.

I’m sure that many reading this will think twice when someone comes in saying they need to update their computer now. It’s not like most people in the hospital know all the tech support people in their hospital.

Of course, this is a simple little hack. Certainly there are plenty of other ways that someone can hack into healthcare systems. The interesting thing is that most people don’t care about healthcare information. They want financial information. So, someone that does hack a healthcare system is unlikely to do much with the healthcare info. Yes, I’ve read the people who say a patient record is worth $50. I’m still waiting to see someone try to sell one at that price.

I should also mention that I think the tweet isn’t actually talking about this type of hacker. I think the tweet is talking about the Fred Trotter version of “hacker” which just puts together a great solution to a problem (ie. a hack). We need more great solutions in healthcare, so I hope that EMR vendors stop impeding local application hackers to work with hospitals.

July 31, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Great Whitepaper Summary of OpenVista Features

The week after I got my first job implementing EHR, I went into the medical records office where I was shown an article about the government’s decision to open source the Vista EHR software. The HIM manager was drawn by the idea of a free EHR. Of course, the clinic I was working for had already invested hundreds of thousands of dollars on an EHR system. In fact, this is likely what made the HIM manager so interested in the idea of a free EHR. She didn’t know why we’d spent hundreds of thousands of dollars when the government was offering an EHR for free.

What she didn’t understand was that just because the software is free doesn’t mean that the EHR is free. Plus, she (and I at the time) had little understanding of what the Vista EHR software really encompasses. Implementing Vista in that small clinic would have been like taking a sledgehammer to a 2 penny nail. In fact, that might even be underestimating the breadth of what could be done with Vista.

Of course, if we had been in the hospital environment, then we should have definitely considered Vista. However, back then there were a lot of unknowns with how Vista would transition to open source and how it would work in a commercial healthcare environment. 8+ years later, the companies working with the open source EHR is much more mature.

One of the leaders when it comes to implementing Vista in hospitals is a company called Medsphere. Medsphere’s version of Vista is called OpenVista. What’s amazing is the stark contrast in costs between an open source EHR versus many of the proprietary alternatives. No doubt Medsphere and others are benefiting from the billions of dollars the VA spent developing Vista.

For those of you not familiar with Medsphere and OpenVista, check out this whitepaper summary of OpenVista. It’s a really great summary of the capabilities of the software and what Medsphere has done to improve on the Vista software.

I’m sure there are still many hospital CIOs that aren’t brave enough to choose an open source EHR when “know one gets fired for buying Epic.” Although, I think it’s a big mistake when hospital CIOs don’t even consider the open source EHR options. When you see the breadth and depth of what’s available in Vista, it’s definitely worth considering.

Plus, since it’s open source, you can still develop custom additions to the software without worrying whether your EHR vendor will let you create a deep connection to the EHR software. I see an open source EHR software as a great option for those hospitals that are use to developing custom applications in house, but also see how a commercial vendor has expertise that they don’t have in house.

What are your thoughts on Vista as a hospital EHR?

July 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Study: Massive EMR Vendor Die-Off Expected Over Next Four Years

Well, if you were waiting for someone to say the sky is falling, here it is.  According to Black Book Market Research, more than half of the EMR vendors in business today are going to fail within the next few years.

Right now, according to Black Book estimates, there are almost a thousand EMR vendors in business, including over 600 smaller vendors. But by the time 2017 rolls around (or Meaningful Use 3 hits) more than half of those vendors will be gone, the research firm says.

To get a feeling for the state of the EMR market, Black Book surveyed 880 EMR consultants, analysts, managers and support team members. Ninety percent of those interviewed predicted that the majority of EMR vendors currently implemented will no longer exist as an independent entity. (They’ll either have merged, been acquired or closed up shop, the experts say.)

Eighty-eight percent of those interviewed believe that vendors who fail will have done so because they didn’t focus on usability, trying instead to turn out systems aimed at Meaningful Use compliance.

That being said, there does seem to be a path to continued independence and success for some vendors. Eighty-two percent of survey respondents believe that well-funded small vendors who carve out a strong niche in medical and surgical specialties – or serve buyers in alternative care settings — will  pick up market share during this period.

All told, these results are no surprise.

For example, it’s quickly becoming established wisdom that specialty EMRs are helpful and even necessary to specialist physicians.  EMRs that attempt to be “all things to all people” are increasingly losing favor with specialists, who want vendors that understand what they do and speak their language.

And the core message — that EMR vendors are going merge, be acquired or go belly up like crazy — is only common sense at this point.

My question is this: will vendors of general-use EMRs begin picking specialties and rolling out related products, or will the weaker all-purpose vendors cling to their model and go down with the ship?

July 23, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

It’s not US (EHR Vendor), it’s YOU (Hospital)

After reading Anne Zieger’s post about an Epic investment that promoted a CIOs departure, I engaged with @LukeDeanNif on Twitter where we discussed the challenge a CIO faces with any large EHR purchase.

Luke keenly observed that a CIO departure could happen with any EMR, not just Epic. Although, I think there’s a bigger challenge when it comes to Epic. Sure, we like to say that “No one ever gets fired for choosing Epic” (a takeoff from the IBM quote). However, that’s not always the case either. In fact, Epic has the perception of successful installs at big name institutions. If your hospitals runs into issues with your EMR implementation, many will question your organization and not Epic for why it’s failed.

You can already hear Epic people saying “We’ve successfully implemented this in XXXX organizations. This must be a problem with your organization.” That’s right, it couldn’t possibly be the EHR vendors fault. At least that’s the story that will be told. Given this, I guess you could say that in some ways it’s more risky for a hospital CIO to choose Epic over other hospital EHR vendors.

One thing Luke and I agreed on is that it’s really easy for an EHR vendor to point the finger at the hospital organization instead of taking responsibility for any issues that may occur. I’m not saying that hospitals are never to blame. In fact, hospitals can often take plenty of the blame for network issues, commitment issues, physician issues, or just plan organizational resistance to change. In fact, I’d say that almost every EHR implementation has a few of these things. The problem I have is that EHR vendors far too often point the finger at the hospital when there’s a problem and they forget about the 3 fingers pointing back at themselves.

July 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospitals, Vendors Seek New Hires

Hospitals and health IT vendors are on something of a hiring binge, with the majority of both groups planning new recruitment over the next 12 months, according to a new study of the health IT workforce from HIMSS Analytics, Healthcare IT News reports.

The HIMSS study, which was published last week, was based on the responses of about 225 executives in the two industry sectors.

More than 85 percent of respondents to the survey said they’d hired at least one employee during 2012, and 79 percent of execs in both industry categories plan to hire additional IT staff during the next year. In sharp contrast, only 13 percent went through layoffs during 2012.

Providers were more likely to say that they were hiring for clinical application support positions and help desk IT staff, while vendors were more likely to be looking for sales and marketing personnel.

Though both segments were hiring, industry vendors were more likely to report having hired staff than providers, according to the Healthcare IT News write-up.

To attract these new hires, both groups cited competitive salary and benefits programs as key, with job boards (70 percent) and employee referrals (69 percent) most frequently used to recruit in both cases.

To retain the staff they recruited, both groups were most likely to use professional development opportunities; telecommuting and tuition reimbursement were also popular.

Despite all of this recruitment activity, some healthcare organizations are falling behind, largely due to the lack of a local qualified talent pool, survey respondents said. And it’s causing problems. In fact, about one-third of providers said that they’d had to put an IT initiative on hold due to staffing shortage.

It’d be nice to think that with the right recruiting razzmatazz in place, these staffing shortages would be a thing of the past. But the reality is, the pool of health IT experts can’t be expanded overnight  – it takes training, possibly subsidized training, and the right kind of training at that.

And as my colleague Jennifer Dennard notes, while certain troublespots are being addressed (for example, building a talent pool for rural hospitals), even those efforts are hamstrung by the reality that students aren’t getting trained on the systems they’ll need to work on when hired.

The reality is that this will continue to be a great time for health IT consultants, even as hospitals and vendors duke it out for permanent  hires.  Hospitals simply can’t put projects of importance off forever.

If you’re looking for a job in healthcare IT or looking to hire someone for a healthcare IT position, be sure to check out the EMR and EHR Job board. It gets a lot of visibility in the sidebar of all the Healthcare Scene blogs.

July 16, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Greenway, Epic Systems Linked Together

These days, it doesn’t take a lot of data interoperability to make news.  The following, while a perfectly fine effort, concerns just one practice and one hospital, something which reminds us forcefully of how far we have to go. That being said, the details are worth a look.

Lancaster General Health’s Women & Babies Hospital, which runs an Epic EMR, has connected the Epic system with the Greenway EMR at obstetrics and gynecology practice May-Grant Associates. The two entities can now exchange continuity of care documents and securely share patient data, according to an article in Healthcare IT News.

According to Greenway, which issued a press release touting the development milestone, the architecture of its PrimeSUITE platform simplifies data exchange between disparate EMR systems, using a bidirectional, hub-based exchange built to support industry standards.  To connect the medical practice with the hospital, Epic needed to create a connection to the Greenway EMR which would enable data flow between the two entities.

The new interoperability between systems is expected to help coordinate care for more than 2,500 patients with the ob/gyn practice whose babies are delivered at the women’s hospital, Healthcare IT News reports.

Moreover, May-Grant expects shared data access to deliver financial benefits. According to the release, since the systems were connected May-Grant has seen improved practice management and revenue cycle management processes, especially when hospital patients are assigned to the practice for follow-up care.

“Now we’re able to get all of the details we need to process claims on behalf of those new patients,” said Mona S. Engle, RN, May·Grant practice administrator. “Since we can query the hospital for the information we need to submit with a claim, searching for that information no longer slows us down.”

As Healthcare IT News points out, Greenway is part of the new CommonWell interoperability alliance announced at HIMSS13 a few  months ago, but Epic is not.  So far, CommonWell members haven’t come out with any specific interoperability proposals of their own, so that probably didn’t matter this time around.

But it’s worth wondering whether CommonWell membership will make a difference going forward — and whether Epic’s non-participation will undercut hospitals’ ability to pull off projects like these. So far, the benefits of the Alliance seem distant and vague at best.

July 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Nurses Want EMR Rollout Postponed

RNs at Massillon, OH-based Affinity Medical Center are demanding that the 266-bed hospital delay the rollout of its new Cerner EMR, arguing that the hospital has done too little to train staff and has failed to involve direct-care nurses in the process of implementation, reports Healthcare IT News.

The hospital’s 250-odd direct care nurses, backed by national nursing union the National Nurses Organizing Committee, wrote a letter to the facility’s chief nursing officer  questioning the safety of the Cerner EMR, which they say prevents RNs from overriding the system in many cases.

The letter also notes that there has been no planned increase in staffing, nor has there been a decrease in the volume of elective procedures to be performed during the go-live process, Healthcare IT News says.

The hospital, for its part, denies that there’s a training gap for nurses. According to Healthcare IT News, the hospital said that it has followed Cerner guidelines, which recommend 16 hours of training for each nurse. Close to 95 percent of nurses have met this requirement, according to a hospital spokesperson quoted by the magazine.

Here at HospitalEMRandEHR we don’t know whether the nurses were able to convince the leaders at Affinity to postpone its official kickoff date, which was June 21st. But if there’s any substance to their complaints — and I strongly suspect there is, I hope management agreed to their request.  Going live with a staff of uncomfortable, less-than-fully trained nurses is a recipe for trouble.

July 5, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Emergency Department EMR Designs Can Compromise Safety

Emergency department EMR designs vary widely, with some having problems which can compromise clinician workflow, communication and ultimately, quality and safety of care, according to a new study reported in the Annals of Emergency MedicineiHealthBeat reports.

The study, which was written by the American College of Emergency Physicians’ work groups on informatics and quality improvement and patient safety, outlines four situations in which EDISs can generate medical errors. According to iHealthBeat, these include:

* Communication failures
* Poor data displays
* Wrong order or wrong patient mistakes
* Alert fatigue

The degree to which these issues emerge in EDs is not consistent, given how widely system functionality varies among EDISs. Factors that lead to this variation include whether the systems were homegrown within the hospital, purchased from a commercial EMR provider or are “best of breed” systems, iHealthBeat reports.

Researchers with the work groups noted there are several factors which hinder efforts to address such issues, including a lack of research on the problems, the lack of a mechanism to collect feedback  from  users on safety concerns systematically, and provisions within vendor contracts which prevent ED professionals from sharing information on software safety.

To improve the performance of EDISs, the researchers recommend the following, according to iHealthBeat:

  • Appointing a “clinician champion” to oversee the EDIS performance improvement process
  • Creating an EDIS performance improvement group
  • Establishing a review process to monitor ongoing safety issues within EDISs
  • Promptly addressing issues that providers, administration and vendors have identified during the review process
  • Making public lessons learned concerning performance efforts
  • Learning and promptly distributing vendors’ patient safety improvements
  • Removing the “hold harmless” and “learned intermediary” clauses from vendor contracts

The work group was particularly emphatic about the need to do away with “hold harmless” and “learned intermediary” provisions in vendor contracts, as such clauses create a lack of accountability among vendors and unreasonably shift liability to clinicians, iHealthBeat notes.

June 28, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

What If EMR Interoperability Was Mandatory?

For decades, industries have haggled and coded and bargained their way into shared data standards.  Each agreement has made great technical advances possible and grown markets into forms which could hardly have been imagined before.

Traditionally, the idea has been agreeing on interoperable standards is a form of enlightened self-interest.  The equasion “interoperability=larger markets=more pie for everyone” has nearly always managed to take root even in industries as brutally competitive as networking.  Consider where we’d be without 802.11 for WiFi, for example. If WiFi manufacturers had staged a prolonged battle over standards, and the reach of WiFi didn’t blossom everywhere, the Internet as we know it might not exist.

Well, here in EMR vendor land, we’ve somehow passed the exit marked “coopetition” and wandered off into interoperability nowhere land.  Sure, tell me about the CommonWell Alliance, which looks, on the surface, something like industry cooperation, and I’ll retort, “too little, too late.”  And do I even have to say that the idea that Epic supports everybody is something of a laughing matter?

Maybe, after seeing how miserably the EMR vendor industry has failed to come together to share data, it’s time to force the matter.  I read that ONC  honcho Farzad Mostashari has occasionally threatened to do just that, but hasn’t followed through with any proposed regs on the subject.

What if the FCC, the FDA and the ONC (which are now taking comments on a regulatory framework for health IT) decide to look at standards, pick a winner and shove it down the ever-living throat of every uncooperative vendor hoping to create dependency on their way of doing things?  That would include Epic, of course, which today, hears countless hospital CIOs say they had to buy their product because everybody else did.

Don’t get me wrong, this is a very, very serious matter; any regs that attempted to force interoperability would impose untold billions in costs on vendors, not to mention their customers. But if interoperability is the real prize we’re ultimately hoping to gain — the big EMR enchilada — is it possible that it’s time to take the risk anyway?  I don’t know, but I certainly wonder.  How about you, readers?

June 5, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.