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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?

Four Things You Should Know About Deloitte’s “Evergreen” EHR Program

Posted on February 20, 2015 I Written By

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

Recently, consulting giant Deloitte announced a new program, named “Evergreen,” designed to cut down the cost of implementing and operating hospital EHRs. Unfortunately, much of the Evergreen coverage in the health IT trade press was vague or downright wrong, as it suggested that Deloitte was actually going into the EHR business itself. The key point Deloitte sought to make — that it could implement and operate EHRs for 20% to 30% less than hospitals — did come across, but the rest was a bit jumbled.

Having spoken to Mitch Morris, global healthcare leader for Deloitte Consulting LLP, I can clarify much of what was confusing about the Evergreen announcement and subsequent coverage.  Here’s some key points I took away from my chat with Morris:

  • Evergreen is a suite of services, not a product:  Though some HIT editors seem to have been confused by this, Evergreen isn’t an EHR offering itself.  It’s a set of EHR implementation and operation services provided by Deloitte Consultants. Evergreen also includes a financing scheme allowing hospitals and health systems to obtain a new EHR by making a series of equal payments to Deloitte over five to seven years. (“It’s like leasing a car,” Morris noted.) This allows hospitals to get into the EHR without making an enormous upfront capital investment over the first 18 months.
  • Evergreen is only offered in tandem with an Epic purchase:  The Evergreen program arose from what Deloitte learned after doing a great deal of work with Epic EHRs, including the famous multi-billion install at Kaiser Permanente and an extensive rollout for large hospital system Catholic Health Initiatives. So at the outset, the program is only available to hospitals that want to go with Epic.  Deloitte is considering other EHR vendors for Evergreen partnership but has made no decisions as to which it might add to the program.
  • Both onshore and offshore services are available through Evergreen:  One might assume that Deloitte is offering lower implementation and operation costs by offshoring all of the work.  Not so, Morris says. While Deloitte does offer services based in India and Ireland, it also taps U.S. operations as needed. Clients can go with offshore labor, onshore labor or a mix of services drawing on both.
  • This is a new application services management offering for Deloitte:  While the consulting giant has been managing Oracle and SAP installations for clients for some time, managing EHR platforms is a new part of its business, Morris notes.

According to Morris, Deloitte expects Evergreen customers to include not only health systems and hospitals that want to switch EHRs system-wide, but also those which have done some acquisitions and want to put all of their facilities on the same platform. “It’s expensive for a health system to maintain two or three brands, but they often can’t afford the upfront capital costs of putting every hospital on the same EHR,” he said. “We smooth out the costs so they can just make a payment every month.”

This could certainly be a big score for Epic, which is likely to scoop up more of the EHR-switching systems if Deloitte helps the systems cope with the costs. And Deloitte is likely to get many takers. Let’s see, though, whether it can actually follow through on the savings it promises. That could change the EHR game as we know it.

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.

Integrating Patient Experience Information Into Your Workflow

Posted on February 18, 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 absolutely intrigued by today’s announcement that Walgreens Pharmacy has integrated PatientsLikeMe data into their pharmacy website. This is the first time PatientsLikeMe has ever integrated their community’s information into a third party website. I think this is a groundbreaking move towards the integration of patient experience information into a wide variety of portals for patients and healthcare providers.

It’s no surprise that a patient facing company like Walgreens is the first to integrate this type of patient generated data. Most healthcare institutions are no doubt leery of patient generated data like this and so they’ll likely be very reticent to integrate this into their systems. However, I think this is a sign of where the integration of patient data is going.

I think the first place we’ll see these type of integrations in healthcare organizations is in the patient portals. I know of many hospitals that have been working to create a kind of PatientsLikeMe experience for their patients. You can see how these efforts could be bolstered by integrating some of the PatientsLikeMe data into their efforts. I’m not sure how much PatientsLikeMe has really opened up their data, but this move tells me that they’re interested in that idea.

So far I’ve only mentioned patient facing integrations. The next step to consider is integrating PatientsLikeMe data into an EHR. Take a look at the image below (click for full size image) to see the PatientsLikeMe integration with Walgreen’s pharmacy website:

It’s not that hard to imagine a similar interface with the PatientsLikeMe data alongside the ePrescribing fields. I’ll leave the discussion of whether this is a valuable integration or not to the doctors. However, PatientsLikeMe is just one example of many that are likely to come. Eventually that data could be genomic data that influences the drug being prescribed. Eventually that data could be “grand rounds” style data that informs a doctor of how his colleagues are prescribing the drug.

As we think through all these data possibilities, it’s easy for me to see that many of these things are not going to be offered by the EHR. So, EHR vendors need to make sure that they get really good at integrating with third party software and data providers. This needs to become a core capability of every EHR vendor.

I’m excited by the possibilities that these types of integrations will bring. What do you think of these integrations? Are they coming? What opportunities are available? Is my vision wrong? Let me know in the comments.

Five Signs You Need a New HIE Solution

Posted on February 17, 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’ve written a lot about the new EHR switching market. EHR implementation software has become quite mature and so we’re entering a new world where new EHR sales are going to come from hospitals switching EHR software. Yes, there are a few hospital EHR stragglers out there, but the majority of new EHR sales are going to come from switching.

While I’d seen this coming in the EHR market for a while, I hadn’t carried that over to the HIE market as well. In this case, I’m really referring to a private HIE that a hospital might employ versus a third party HIE provider. Is the HIE market in a similar “switching” market like EHR? I’d love to hear your thoughts on this.

This question came to mind when I found this eBook called, Five Signs You Need a New HIE Solution. It’s a free download if you want to check out the whole eBook. The 5 signs it suggests are worth some discussion:

  1. My data sharing solution isn’t meeting my needs, but the thought of replacing it is painful.
  2. My technology is old. We need an architectural update.
  3. I can’t access or share my data when I need to.
  4. I can’t make changes to my HIE solutions without my current vendor’s involvement. Plus, they take too long and charge too much.
  5. I don’t feel confident that my current HIE partner is well equipped to handle healthcare’s changes, challenges, and uncertainties.

It’s amazing how universal these signs are with any software. This list could have applied to EHR software as much as HIE. In the eBook, they discuss each of these in more detail. I’m sure that many of these issues resonate with readers.

As I look through this list, I wonder if switching software is the only way to solve the problem. I think in most cases the answer is that switching is the only solution. The reason many don’t switch is fear. Plus, that fear is exacerbated by colleagues from other organizations who have switched their system and not seen an improvement. That’s why so many organizations stick with The Devil You Know for much longer than they should. Hopefully the above list of signs will help people who are going through this evaluation. Just make sure that if you do need to switch HIE or other software that you take the time to make sure your new software won’t suffer the same issues.