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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.

Judy Calls Epic “Most Open System I Know”

After Zina Moukheiber from Forbes was declined an interview with Judy Faulkner, CEO of Epic, last year Judy decided to talk to Zina about Epic in this article “An Interview With The Most Powerful Woman In Health Care.” Zina does a nice job on the interview and raises some of the questions many people have about Epic. It’s worth a read if you like to follow the hospital EHR world.

Many people are likely going to latch on to Zina calling Judy Faulkner the “most powerful woman in health care.” I don’t think that’s really up for discussion. Judy is the most powerful woman in healthcare and so I’m really glad that Judy is starting to join the discussion about Epic and healthcare. She has an important voice in the discussion and we need her participation. Although, I’m sure she’ll hate being called a billionaire in the article. The reality is we don’t know how much Judy’s really worth until we know how much Epic is worth and I’m not sure Epic plans to go public anytime soon.

Semantics aside, the most important part of the interview was the discussion of Epic being a closed system to which Judy frankly replied, “We are the most open system I know because we’re built as a database management system, and database management systems need to allow their users to mold it to what they need.” I think she really believes that Epic is an open system and quite frankly there aren’t that many in healthcare she can look to that are more open. Sure, a number of EHR vendors have worked to be more open, but even they aren’t as open as many other non health IT software systems. Maybe Judy hasn’t looked at the APIs outside of healthcare.

The real disconnect I had when reading Judy’s thoughts on being open is her lack of understanding of how a truly open API works. In a well implemented API, you can allow any and all programmers to be able to build applications on top of your software without those programmers needing to read your code and study your internal software. I’m not saying you don’t want and need to have an application and verification process for those people who want to tap into your API. This can be part of the process, but a well implemented and documented API can be open to everyone interested in building on top of your software. The value Epic would receive from so many companies iterating and extending the core Epic functionality would be amazing.

The other facet of Epic openness discussed in the article was around interoperability. Judy offered these comments on Epic’s ability to share patient records:

As of March 2013, our customers exchanged 760,000 patient records per month; about one-third were with non-Epic systems. Based on the historical trajectory, we expect that we’re closer to exchanging approximately one million records per month. We are currently exchanging data with Allscripts, Cerner, Department of Defense, Veteran Affairs Administration, Social Security Administration, eHealth Exchange (formerly Nationwide Health Information Network), Greenway, MEDITECH, NextGen and others. We expect to be exchanging data soon with eClinicalWorks, General Electric, Surescripts, and others.

This sounds good on face, but lets consider how many records Epic is sharing. Let’s use the round number of 1 million patient records shared per month. The article says that Epic has about half of the US population on Epic, or about 150 million patients. That means that about 0.67% of Epic’s patient records are being shared.

I’m happy to applaud Epic for sharing 1 million records a month with so many different vendors. My only complaint is that they could do so much more. For example, if you can share records between Epic and Cerner now, does that work for all Epic hospitals or do you have to do the new integration with every hospital that says they want to share records with Cerner? If it was a turn key way to integrate with Cerner, I’m quite sure that instead of 1% of Epic’s patient records being shared we’d see tens of millions of patient records flowing where they needed to go.

Many might remember my surprise breakfast with Judy Faulkner at the CHIME Forum. From my personal experience, Judy is not the black widow that I’ve heard many portray her to be. In fact, I found her incredibly thoughtful, caring, and really interested in quality patient care. That’s why I hope Judy will see that she’s sitting on an opportunity to do so much more than she’s doing now. Although, it will take a shift in her understanding of what it means to be an open EHR. Right now it seems her mostly unfounded fears won’t let her see the possibilities.

May 16, 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.

Epic Module Targets Patients For Care Coordination

At Gundersen Lutheran Health System, executives have put together a program to target the 1 to 2 percent of those most likely to be hospitalized, seen in the emergency department or face other complications. To manage the program, the La Crosse, Wis.-based system is leveraging a feature of their Epic EMR which sifts out the patients most in need of additional care coordination, reports Health Data Management.

Gundersen Lutheran is targeting complex patients with its program, but not just those with medically-complex conditions. They’re also hoping to find patients who, while they might have simpler conditions, live alone or have trouble following sometimes difficult medical care plans.  The system is using the EMR first to identify the patients, then to treat them, according to Health Data Management.

To find patients in need of extra care coordination services, Gundersen is using a “tiered scoring” module built in to the Epic platform which includes one component for medical complexity and another to measure psycho-social issues. When clinicians want to refer a patient to the care coordination program, physicians use the Epic scoring tool to see if  the patient qualifies. Clinicians can also notify the care coordination team using the Epic system, in three clicks or less, noted Beth Smith, R.N., executive director of patient and family-centered care at the health system.

The patients identified by the scoring model as in need of extra care coordination are farmed out to a group of 22 nurses and social workers, whose job it is to monitor the care of these complex patients who are more likely to face adverse events.

The workload the care coordinators face is intense.  Typically, care managers are supervising some 1,700 patients each, who not only stay in touch with patients but also attend office visits and follow through with specialists.  Epic plays a role here too, however.  Care coordinators get a special tab in the Epic EMR which pulls key elements of the patient’s history into a single view,  making it easier to get a sense of the whole patient.  Epic also notifies them via a message in the system if a patient shows up in the ED.

According to Health Data Management, this program has helped stabilize hypertensive and diabetic patients, with just under half showing sustained improvements over a two-year period.

May 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.

Cleveland Clinic Brings Epic Smarts To NY Hospital Practices

The Cleveland Clinic is going the consulting route, this time around by working with the physician and specialty practices for a New York hospital to bring Epic up to speed.

Glens Falls is a 410-bed nonprofit which began implementing the Epic EMR in early 2012. The New York facility has 3,000 employees and 28 regional locations.

Apparently dissatisfied with its internal knowledge base on the subject, It’s now contracted with the Clinic’s MyPractice Healthcare Solutions (MPHS) to help deploy and optimize its rollout, reports the Cleveland Plain Dealer.

Among the Epic products installed at Glens Falls is “MyChart,” offering a clinical and billing records portal for patients, according to the Plain Dealer.

The Cleveland Clinic has had Epic in place for more than 10 years, making it one of the first healthcare systems in the country to install the vendor’s product. Having learned from that experience, Cleveland Clinic MPHS now brings project management and implementation expertise to other facilities.

I think this is an interesting business model for the Cleveland Clinic, and I’d be curious to see what other consulting agreements it has put into place. (So far I wasn’t able to turn up any others but my guess is that they exist.)

It seems to me that hospitals who have tamed Epic — Kaiser Permanente comes to mind — might very well go into this line of business, as the need is great. Not to mention that if I were making a decision as to who I’d hire to wire my medical practice into my hospital, a successful institution would have a very strong pitch to make.

Can any of you readers share other examples of hospitals/clinics who are turning their Epic experience into a consulting revenue stream?

May 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.

W. VA. Rolls Out Enhancements To VistA

Officials with the West Virginia bureau of behavior health and health facilities are putting some finishing touches on VistA installations cutting across the state, adding computerized laboratory information to a six-year-old implementation.

West Virginia officials have implemented Vista in seven communities, Modern Healthcare reports. Facilities include an acute-care hospital, two psychiatric hospitals, four long-term care hospitals, a nursing home and two ambulatory care clinics.  The facilities are all connected to a central database in Charleston via T1 lines.

The state has been working on contract with Medsphere Systems Corp. to install a VistA version known as FOIA VistA, a version in the public domain that can be obtained freely from the VA under the Freedom of Information Act, Modern Healthcare notes.

Though VistA itself is free, the state has spent heavily on installing it across the seven sites.  Since FY 2005, West Virginia has paid Medsphere $8.4 million for system implementation, development and support, and is contracted to pay the vendor $939,800 this year for support.

In addition to paying Medsphere a monthly fee for systems support, the state pays licensing fees to InterSystems, developer of Cache, a version of the MUMPS database and programming language. It also licenses Keane’s financial system, which interfaces with VistA.

West Virginia began looking at a common infrastructure for all of its facilities when HIPAA passed back in 1996, noting that the idea behind it was portability and accountability. Now state officials are glad they moved ahead. “It’s expensive,” but “in terms of satisfaction, I think we’d all agree it was well worth it,” deputy commissioner for administration Craig Richards told the magazine.

May 7, 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.