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By Tradition, or By Design?

Posted on March 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.

A few of my healthcare social media family are my friends on Facebook and so a get a smattering of work on my Facebook account. Today when I was browsing through my Facebook feed (likely avoiding some other work) I found this great question from Dirk Stanley, MD, MPH (@dirkstanley), and CMIO at Cooley Dickinson Hospital:

By Tradition, or By Design?

4 words that caused me to stop my day and think. Hopefully it does the same for you.

Dirk is a great guy if you don’t know him. I love running into him at HIMSS since he always seems to be hanging around a bunch of other CMIOs who are overwhelmed by the craziness of HIMSS. It then leads to great conversations since he’ll pose questions like the one above.

There are so many ways we could talk about the question of tradition and design in healthcare. I think we could all come up with examples where tradition was an amazing thing for healthcare and where tradition has been detrimental. The same could be said for design. Like in most things in life, it depends.

With that as framework, I’m more interested in talking about how often we’re stuck designing around traditions. When the tradition is a good thing, that can lead to excellent results. When the tradition is a bad thing, it can lead to awful results. Once our traditions are incorporated into design, it’s REALLY hard to change those traditions.

Our billing system is a great example of this challenge. EHR systems were built around the traditions we’ve created in our billing system. For doctors wanting to be reimbursed for their work, it’s been a good thing. They need to get paid and early iterations of EHR were often able to get doctors paid at a higher level just based on their ability to create more complete documentation. The tradition of creating fluffy documentation that would get paid at a higher level has now been designed into most EHR systems. Every doctors knows the impact of this and it’s not a very pretty result. Plus, now it’s EXTREMELY hard to change.

The good news is that the only way to solve this problem is to design new traditions that avoid these challenges. That’s what they’re trying to achieve with ACOs. Although, the above example should be a warning to those designing these new reimbursement models. If you design them well so they become a tradition that’s integrated into our systems, all will be well. However, the opposite is also true.

By Tradition, or By Design? I’d love to hear your thoughts.

Dell Healthcare Think Tank Live Stream (#DoMoreHIT) and My EHR Training Course in Dubai

Posted on March 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.

I’m excited to once again be taking part in the Dell Healthcare Think Tank event (I believe this is my third year). I’m glad they like what I offer and keep inviting me back. In case yo umissed it, here’s a look at my final words from the last Dell Healthcare Think Tank event. Dell always does a great job putting together the event and I expect it to be the same again this year.

In case you haven’t followed previous events, you can follow all of the action online via the #DoMoreHIT live stream or by following the hashtag #DoMoreHIT on Twitter on March 16, 2015 from 8-11 AM PT (11-2 PM ET). I’ve seen a preview of the topics we’ll be discussing and it’s a juicy smorgasbord of consumer engagement, social media, the patient/payers/providers gap, and healthcare entrepreneurship and innovation. Plus, take a look at the amazing panel of participants (click on the picture below) including the incomparable Mandi Bishop and the man who’s everywhere Eric Topol, MD.


This year’s event is happening during the hustle and bustle of SXSW in Austin, TX. So, I’m sure we’ll be enjoying some music and socializing the night before the event somewhere on 6th street if you’d like to connect while I’m in Austin. Just drop me a line if you’d like to know where we’ll be.

Also, you can join in on the conversation using the hashtag #DoMoreHIT on Twitter. I’m sure many of us will be watching the Twitter stream while participating so we can answer your questions and incorporate any thoughts you have to share.

3 Day EHR Training Course in Dubai
I’m excited to be working with ACS to offer a special 3 day EHR training workshop in Dubai on May 24-26, 2015. It will be 3 full days where we take a deep dive into the world of EHR and EMR. We won’t be training on specific EHRs (that’s a different course), but we’ll be talking about a wide variety of subjects related to EHR including: EHR and Governments, EHR Features to look for, EHR ROI, and other healthcare IT trends that relate. You can see the full schedule here.

If you’re in the Dubai area or know of someone that works there, let them know about the training. There are only a limited number of slots in the class, so sign up now if you’re interested.

I’ve also started to update my Spring 2015 Healthcare IT conference and event schedule. I imagine I’ll add a few more events this Spring and Summer, but HIMSS and the Healthcare IT Marketing and PR Conference do take up most of my spring. I hope to see many of you on the road or on social media.

Health System Investment in Single EHR Platform

Posted on March 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I heard about this investment at an ACO conferences in Las Vegas. It had been a while since I’d written about the hospital subsidizing the cost of an EHR for their affiliate providers. We all know they’ve been implementing an EHR with their owned practices. However, in a lot of areas the hospital is also spending a bunch of money subsidizing the cost of EHR for their affiliated providers as well.

The above comment is even more interesting in the context of an ACO. Basically, this health system’s progress towards an ACO gave them a really great reason why they should spend money on an EHR for even their affiliate providers. They obviously saw a lot of value in having all the providers and hospitals on a single EHR. Otherwise they wouldn’t have made an investment like this.

This also seems to highlight their bleak outlook on healthcare interoperability. If interoperability was a reality, would they really care that much about having everyone on a single EHR platform?

What is absolutely clear to me is that an ACO needs technology to connect all of the entities in the organization. The single EHR approach is one way. However, there’s a really strong argument to be made that most ACOs are going to be a heterogeneous environment. Where does that leave the ACO?

When Your EHR Goes Down…And It Will

Posted on March 5, 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.

Erin McCann at Healthcare IT News wrote a recent report on a McKesson EHR outage at Rideout Health after an HVAC unit burned out. In the article she also talks about the $1 billion (I love that she added the price tag) Epic EHR outage that occurred in August 2013 at Sutter Health and lasted an entire day. Plus, she mentions the IT network failure at Martin Health System in January 2014 and had their Epic EHR down for 2 days. I’m sure there are many more that were shorter or just weren’t reported by news outlets.

When I think about EHR downtime I’m reminded of the Titanic. You can invest all you want in the “unsinkable” EHR implementation and unexpected downtime will still occur. Yes, much like the Titanic that everyone thought was totally unsinkable, it now lies at the bottom of the ocean as a testament to nature’s ability to sink anything. That includes causing your EHR to go down.

Let’s say your EHR is able to have 99.9% uptime. That would feel pretty good wouldn’t it. Well, that turns out to be 8 hours 45 minutes and 57 seconds over the year. That’s still a full working day of downtime. If you expand to 99.99% downtime, that’s still 52.56 minutes of downtime. At 99.999 (Five Nines as they say in the industry) of downtime is 5.39 minutes of downtime.

The challenge is that with every 9 you add to your reliability and uptime requirements the costs increase exponentially. They don’t increase linearly, but exponentially. Try getting that exponential cost curve approved by your hospital. It’s not going to happen.

Another way to look at this is to consider tech powerhouses like Google. They have some of the highest quality engineers in the world and pay them a lot more than you’re paying your hospital tech staff. Even with all of that investment and expertise, they still go down. So, why would we think that our hospital EHR could do better than Google?

One way many organizations try to get a Google like uptime in their organizations is to use an outside data center. Many of these data centers are able to implement and invest in a lot of areas a hospital could never afford to invest in. Of course, these data centers only provide a few layers of the technology stack. So, they can minimize downtime for some things, but not all.

The real solution is to make sure your organization has a plan for when downtime occurs. Yes, this basically means you assume that your EHR will go down and what will you do? This was my first hand experience. At one point the EHR that I implemented went down. The initial reaction was fear and shock as people asked the question, “What do we do?” However, thanks to a strong leader, she pulled out our previously created plan for when the EHR went down. Having that plan and a strong leader who reminded people of the plan calmed everyone down completely. It still wasn’t fun to have the EMR down, but it was definitely manageable.

What have you done to prepare for EHR downtime? Do you have a plan in place? Have you had the experience of having your EHR down? What was it like? Are you afraid of what will happen in your hospital when your EHR goes down?

Hospitals Publishing Algorithms and Improving Adherence

Posted on March 2, 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.

Today I wanted to pair two seemingly unrelated tweets to talk about the shift that’s happening in healthcare and also what I hope is happening. Let’s start off with the big announcement that Mayo Clinic is starting to share it’s algorithms that improve patient outcomes on the Apervita platform.

I’ve long wanted some way for algorithms that are discovered to be easily shared. I’ll admit that I haven’t dug into the Apervita platform yet, but I’m interested in seeing how they’re trying to solve the problem of algorithm sharing. I’ll be looking to see what their business model is and if it makes sense from everyone’s perspective. It’s a challenging problem that I’d love for people to solve since it will make our healthcare system better.

This next tweet dives into the question of data versus the actual result of improving health:

I agree with Dr. Morrow that we have a lot of data and we haven’t done much to get all the value we could out of that data. Plus, even if you have great data, there’s a gap between understanding the data and getting the patient or doctor to do something about that data.

I love these two topics paired together, because I think the first step to converting data to adherence is to find the right algorithms that analyze the data. The right algorithms can indicate who to engage with to improve adherence. In many ways, getting people to improve adherence won’t be a tech solution at all. Instead it will be a human interaction that was prompted by great algorithms that poured over all the data we do have. That’s a powerful concept and one that needs to be shared.

RNs are Choosing Where to Work Based on Hospital EHR

Posted on February 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across this tweet and it made me stop and realize how important the selection and more important the implementation of your EHR will be for your organization. In many areas there’s already a nurse shortage, so it would become even more of an issue if your hospital comes to be known as the hospital with the cumbersome EHR.

Here’s some insight into the survey results from the article linked above:

79% of job seeking registered nurses reported that the reputation of the hospital’s EHR system is a top three consideration in their choice of where they will work. Nurses in the 22 largest metropolitan statistical areas are most satisfied with the usability of Cerner, McKesson, NextGen and Epic Systems. Those EHRs receiving the lowest satisfaction scores by nurses include Meditech, Allscripts, eClinicalWorks and HCare.

The article did also quote someone as saying that a well done EHR implementation can be a recruiting benefit. So, like most things it’s a double edge sword. A great EHR can be a benefit to you when recruiting nurses to your organization, but a poorly done, complex EHR could drive nurses away.

I’m pretty sure this side affect wasn’t discussed when evaluating how to implement the EHR and what kind of resources to commit to ensuring a successful and well done EHR implementation. They’re paying the price now.

Department of Defense (DOD) and Open Source EHR

Posted on February 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was intrigued by a report by the Center for New American Security that was covered in this article on HealthcareDive. In the report, they make a good case for why the Department of Defense (DOD) should select an open source EHR solution as opposed to a commercial solution. Here’s an excerpt from the article:

“I think the commercial systems are very good at what they do,” Ondra said. However, “they are not ideally designed for efficiency and enhancement of care delivery, and I think the DOD can do better with an open source system both in the near-term, and more importantly in the long-term, because of the type of innovation and creativity that can more quickly come into these systems.”

Reports like this make a pretty good case for open source. Plus, I love that it also pointed out that commercial EHR vendors were built on the back of the fee for service model which doesn’t matter to the DOD. It was also interesting to think about the DOD’s selection of an open source EHR system as an investment in other hospitals since the money they spend on an open source EHR could help to catalyze the ongoing development of a free open source EHR solution.

While these arguments make a lot of sense, it seems that the DOD has decided not to go with an open source EHR solution and instead is opting for a commercial alternative. In this article (Thanks Paul) the DOD has narrowed the list of contenders for the $11 Billion DOD EHR contract (DHMSM) to just: CSC/HP/Allscripts, Leidos/Accenture/Cerner, and IBM/Epic who “fall within the competitive range.” They reported that PwC/Google/GDIT/DSS/Medsphere and Intersystems did not fall within the competitive range.

I’ll be interested to hear Medsphere’s take on this since every report I’ve ever read has Medsphere and their open source Vista solution as much less expensive than the commercial alternatives (Epic, Cerner, Eclipsys). So, I can’t imagine that the Medsphere bid was so much more than the others. Unless the consultants are charging through the nose for it. Or maybe the open source Vista option wasn’t “in the competitive range” because it was too cheap. Wouldn’t that be hilarious to consider. Hopefully the government isn’t that stupid, but…

I don’t claim to have any clue on how these $11 billion government contract bids work. I’m just a casual observer from the sideline. It seems like 3 companies remain in the ring. I guess the Google juice wasn’t enough for the PwC/Medsphere bid.

Cerner Offers Voluntary Separation Packages

Posted on February 24, 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.

The Kansas City Star is reporting that Cerner is offering employers whose combination of years of service and age total 65 have been offered voluntary separation packages. Here’s an excerpt from the article:

Cerner spokesman Dan Smith said the one-time offer reflects the “deep bench of complementary talent” because of the Siemens acquisition and doesn’t affect Cerner’s continued hiring or its future growth plans.

“This is a truly voluntary program for all of our U.S. associates,” Smith said. “There is no pre-determined outcome and no number to hit. It provides eligible associates who might be ready to make a change the chance to decide to stay or pursue a different option and get benefits not normally associated with voluntary departures.”

With any large acquisition like the one Cerner did of Siemens, there has to be a lot of duplicate functions and they have to look at how to trim back the number of employees. So, this shouldn’t come as any surprise. In fact, I think the fact that they’re currently doing a voluntary separation package might mean that they aren’t looking to slim down the company as much as you’d think. Some investors might think that’s a bad plan since every company the size or Cerner or Siemens (let alone the combined company) could likely fire 10% of the workforce and improve their company’s profitability. Although, it could also be a sign of how much growth Cerner is experiencing.

Personally, I’ll be watching to see if they announce some other layoffs. It will be a surprise to me if they don’t announce some involuntary layoffs. Either way, this is a normal part of an acquisition like this.

It does make me wonder how many of these older professionals that accept the voluntary separation packages will end up at the wide variety of EHR consulting companies out there. You have to think that would be a pretty sweet deal for them.

Two Competing Challenges: Integration and Innovation

Posted on February 23, 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 my other post about BIDMC’s webOMR acquisition by Athenahealth, I found this old post from John Halamka about the best of breed healthcare IT application approach and the all in one integrated EHR approach. In that post, I was really struck by the way John Halamka describes the challenge of balancing innovation and integration:

Innovation:

Epic eases the burden of demand management. Every day, clinicians ask me for innovations because they know our self-built, cloud hosted, mobile friendly core clinical systems are limited only by our imagination. Further, they know that we integrate department specific niche applications very well, so best of breed or best of suite is still a possibility. Demand for automation is infinite but supply is always limited. My governance committees balance requests with scope, time, and resources. It takes a great deal of effort and political capital. With Epic, demand is more easily managed by noting that desired features and functions depend on Epic’s release schedule. It’s not under IT control.

Integration:

Most significantly, the industry pendulum has swung from best of breed/deep clinical functionality to the need for integration. Certainly Epic has many features and overall is a good product. It has few competitors, although Meditech and Cerner may provide a lower total cost of ownership which can be a deciding factor for some customers. There are niche products that provide superior features for a department or specific workflow. However, many hospital senior managers see that Accountable Care/global capitated risk depends upon maintaining continuous wellness not treating episodic illness, so a fully integrated record for all aspects of a patient care at all sites seems desirable. In my experience, hospitals are now willing to give up functionality so that they can achieve the integration they believe is needed for care management and population health.

These comments also say something significant about IT governance as well. It’s a challenging balance. Although, it also illustrates why a well done EHR API is so powerful. It allows a large organization to have deep integration into an EHR while not having to sacrifice the ability to innovate. Too bad APIs are Hard and so many EHR vendors haven’t executed on them. We’ll see if FHIR can get us at least part of the way there.

How do you approach innovation and integration in your hospital? What’s the right balance?

The Epic App Store (Epic App Exchange) Is Coming

Posted on February 19, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Wisconsin State Journal is reporting that Epic is working on the Epic App Store which will be called the Epic App Exchange. I guess the news was mentioned by Mark Bakken, co-founder and former chief executive of Nordic Consulting, at a Wisconsin Innovation Network event and confirmed by Shawn Kiesau, Epic spokesman. Here’s a quote from the article:

Bakken said the app store will launch in a few weeks and it will “open the floodgates” for all sorts of companies to develop and market their apps, especially those in the Madison area populated by former Epic employees.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” Bakken said later in an interview.

Bakken has obviously drunk the Epic Kool Aid having created a very large Epic consulting firm in Madison and he’s now creating an investment fund called HealthX Ventures that’s focused on healthcare IT startups with many of them created by former Epic employees. He is right that an Epic app store with a robust API could be an awesome opportunity for Epic and entrepreneurs.

What’s not clear to me from this initial news is how open the Epic app store will really be. If it’s like their previous Epic API, it wasn’t much to write about. It didn’t allow an app to integrate deeply with the Epic system. Will we once again be disappointed by the Epic App Store, or will they start to really open up Epic to entrepreneurs who want to build applications on top of their systems?

My gut tells me that the former is more likely. This actually puts people like Bakken with deep relationships with Epic at a real advantage. My bet is that Epic will only work with companies and organizations that they trust and so these already existing relationships could become even more valuable. While it’s true that Epic should be careful with how they work with external companies that want to leverage the new Epic app store, there are ways they can protect their customers and patient data while still opening up their application to entrepreneurs of every kind. We’ll see if I’m wrong about this. Maybe they will really open things up, but I’m skeptical that they’ll be able to overcome their fear (unfounded as it may be).

In the article linked above, Bakken is quoted as saying that “he expects the first apps to come from Epic’s customer.” This would confirm my prediction above that Epic will be afraid to really open up its platform to entrepreneurs and instead will focus the app store on their closed customer ecosystem. Even the name “Epic App Exchange” hints at this being the case. They want their customers to exchange apps. They aren’t looking to create a true app store where entrepreneurs can innovate on top of Epic’s base.

Of course, since Epic doesn’t like to work with the media very much, it’s hard to know what the Epic App Store will really look like when it’s launched. This is a step in the right direction for Epic. I just still don’t think Epic understands the opportunity that they have to really improve healthcare and solidify themselves as the go to leader in healthcare IT. I’ll continue to hope I’m wrong and Epic will blow us away with the official announcement and details of a really open app store and API.