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Nurses Have Love-Hate Relationship With EMRs

Posted on September 26, 2016 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.

Data collected by a nursing degree program suggests that nurses have a love-hate relationship with EMRs, one which acknowledges many flaws but also suggests some degree of satisfaction.

The data, which was gathered by Adventist University of Health Sciences RN to BSN Online Program, offers a window into how nurses feel about hospital EMRs. And much of what they feel doesn’t reflect well on hospital EMRs.

For example, the graphic notes that in 2014, 92% of nurses were dissatisfied with EMR they had to use. Eighty-four percent said the EMR disrupted workflow and productivity, and 85% complained of “continually flawed” EMR systems. In other words, not only did they see their EMRs as flawed, they saw it as broken.

And these weren’t just vague expressions of discomfort. Ninety percent of nurses surveyed by the study said that EMR is negatively impacting interactions between nurses and patients, a fairly concerning claim. What’s more, 94% said that EMRs had failed to improve communication between nurses and doctors.

On top of everything else, a large percentage (88%) blamed high-ranking hospital administrators staff for selecting cheap systems. Isn’t it great to hear that EMR rollouts are alienating nurses as well as doctors? Just lovely.

On the other hand, surprisingly, 71% of nurses told a different study that they would not consider going back to paper-based medical records. Also, in other research, 72% agreed that EMRs help to improve patient safety and avoid medication errors, and 73% felt that EMR’s were enabling collaboration with other clinicians inside their organizations.

Looking at this collection of data, a few things stand out:

  • Generally speaking, nurses seem more comfortable with EMRs than physicians, more of whom seem to feel that EMR systems create obstacles to providing good care. But they’re frustrated nonetheless.
  • Too many nurses seem concerned that their EMR is glitchy technically. This should worry hospital administrators, because even if this perception is false, it’s a real problem if nurses believe that they can’t provide adequate care using the system.
  • Given that more than two-thirds of nurses responding to one study wouldn’t go back to paper, clearly some hospitals are doing things right (or at least paper was even worse than EHR).

Of course, nurses don’t develop ideas about EMRs in a vacuum. Hospitals can do a great deal to help nurses become comfortable with their new or upgraded EMR, such as enlisting the support of the chief nursing officer in any rollouts that take place and appointing nurses as EMR champions along with physicians. Not to mention ensuring appropriate training even after go-live.

Also, hospitals can do much to set appropriate expectations for EMR use. For example, I’d wager that few hospital IT leaders see EMRs as a particularly apt tool for supporting collaboration (though they might hope that it becomes so in the future). Being clear to nurses as to what they can realistically expect to do with an EMR — and what future features might be — makes it more likely that they’ll appreciate what the system can actually do. Like anybody else, if a nurse knows what they’re getting into with an EMR system, they are more likely to be on board.

Getting the Team in an EHR State of Mind

Posted on September 23, 2016 I Written By

For the past twenty years, I been working with healthcare organizations to implement technologies and improve business processes for nearly twenty years. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

Recently I had the opportunity to do something different, fun, and unexpected – I opened a team meeting with a music video.

I am currently leading an EHR implementation. Each month, I hold a meeting of the nearly 80 hospital staff members who are part of the project. The meetings combine sharing information about the project with each other, team building activities, and teaching them about change management, process improvement, and team dynamics techniques. I am always looking for a way to make each meeting interesting and memorable.

This month I wanted to initiate a good dialog in the meeting about a topic I wanted to address head-on: Why do Physicians Hate EHRs? And what are we, as a team, going to do about it to make our physicians love their EHR?

It reminded me of a great video crated by a physician right here in Las Vegas, ZDoggMD, whose videos I found through Healthcarescene.com. Viewing it again, it was indeed the perfect way to set the stage for this discussion. Fun, entertaining and such an accurate representation of how physicians feel about these applications.

The video itself got the team excited, motivated, and laughing – and led to one of the most engaging, productive, and thought-provoking conversations we have had on the project.

For the project leaders out there – I would recommend trying this type of technique with your teams.

For any physician or anyone else who has used an EHR and has not seen this music video, enjoy and share if it represents your point of view about EHR applications:

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Clinical System Replacement & Decommissioning: Migrate or Archive? – Tackling EHR & EMR Transition Series

Posted on September 21, 2016 I Written By

clinical-system-complexity
(See Full Healthcare Data Archival Infographic)

A Maturing Healthcare IT Landscape
If 2010 was the year of EMR implementations and optimization driven by initiatives like Meaningful Use, the ARRA, and Obamacare, then 2015 might be known as the year that clinical application retirement became a prevalent topic for many mature healthcare organizations.

Application retirement is nothing new. Large organizations both inside and outside of healthcare have had application retirement strategies in place (typically doled out by expensive consulting companies with fancy matrices, methodologies, and graphs in tow) for a decade or more. Anytime an organization outlives a large IT system (or, in many cases, that system’s vendor), retirement becomes a pressing need. In the case of healthcare, the two largest driving factors forcing clinical application retirement are the consolidation of organizations into large integrated care delivery networks, and replacement of existing electronic healthcare record systems due to poor usability or inadequate functionality.

Migration and Archival – Not Migration Versus Archival
One question that often comes up early on in the process of clinical application retirement is whether it’s necessary at all if the data in these systems is also being migrated into a new EMR. Conversely, the question of whether the cost of a migration is worth it if the archival solution being considered supports some sort of continuity of care solution like seamless single sign on from the new EMR. In most cases, it turns out that the ideal approach is migration and archival.

Just Migrate?
The process of EMR data migration almost always results in some fairly fundamental alteration of the legacy EMR data. The data models used by different EMRs are typically quite different, and it’s not a matter of export/import. Instead, it’s a true ETL process – extract, transform, load.

The shape of the data is changed. Sometimes data types undergo conversions, such as a number to a string, which if done poorly can result in loss of precision. Data sets, such as order codes, result codes, diagnosis categories, note types, and various other types of dictionaries are mapped from the values in the legacy EMR to the values used by the new EMR. Fields that have no apparent corollary in the new EMR are often just dropped entirely. It’s frequently not possible to know for sure what the data actually looked like in the legacy system once this process is complete and the legacy system is actually retired.
legacy-ehr-archive
Not only that, but from a clinical perspective, it’s probably not useful to take 15 years of legacy data and load that directly into your new EMR. Most organizations opt for something more likely to be relevant, while still remaining safe; perhaps 3 to 5 years of data. While the state and federal requirements for archival are clear on how long you need to preserve data (from 6 years to forever, depending on a variety of factors), they aren’t nice enough to say that the data you need to preserve is limited to what’s usually currently clinically relevant. In other words, that 10-year-old test result is still, technically, part of the legal medical record.
legal-medical-record-and-continuity-of-care
Some EMR vendors will even outright limit the mechanisms for data import to something like a CCD (clinical continuity document) import, which inherently limits the scope and quantity of available data that can be preserved.

Just Archive?
Ok. You give up. Obviously a migration isn’t going to cover us, and if the archive has everything we need legally and clinically, let’s skip that time consuming and expensive migration and just archive. Well, you can do that, but just archiving means that your organization is abandoning millions of dollars of hard won documentation and all the automation and analytics that goes with that.

An EMR is a lot more than a place to store clinical documentation. Virtually all modern EMRs have substantial functionality surrounding clinical decision support, health maintenance planning, and quality reporting. They also often are crucial source of data for analytics suites that are the pillars of population health management. In short, not migrating this data means you should have just stuck with paper charts until your latest and greatest EMR was available.

It’s certainly possible to bring over data in a manual, piece meal fashion as patients are seen or based on some other reasonably predicable event whose workflow can be augmented. This will, eventually, patch up the gaps in data that not performing a migration results in. If your organization is willing to suffer the significant, but probably short to medium term repercussions of temporarily losing this data in your EMR and related operational data repositories, then migration might not be necessary.

Not All Archives Are Created Equal
Inside the world of data archival, there are nearly as many different types of archives as there are vendors. Many of the existing archival solutions that have gained popularity with large healthcare organizations are ones that are also frequently utilized by other sectors and often claim to be able to “archive anything”. This can be very appealing, as an organization going through a merger will often retire dozens or even hundreds of systems, some clinical, but most only tangentially related to the delivery of care. HR systems, general ledger financial systems, inventory management, time tracking, and CRMs are just a few of the systems that might also be slated for the chopping block. The idea of retiring all of these into a single logical archiving is very appealing, but this approach can be a dangerous one. The needs of healthcare are not necessarily the same as the needs of other sectors.

Some factors that make healthcare different include:

  • The highly complex data models used by electronic healthcare record systems.
  • The common need for specialized user interfaces to properly visualize the data.
  • The continuing need for clinicians to seamlessly access the archived data with minimal workflow interruption.
  • The incredible variety of source systems that are in need of archival.
  • The lack of data format standards to make it easy to determine what needs to be archived.
  • The need for HIPPA and HITECH compliance (think encryption and auditing).
  • The massive size of the data to be archived, the need to constantly add new sources of data to an existing archive as the organization expands.
  • The frequent need to rapidly produce specific subsets of archived data during an eDiscovery proceeding or other legal compliance scenarios.

Summary:

  • There must be a clear distinction made between “migrated” or “converted” data and archived data, as the drivers and considerations for each are different. Retiring a legacy application and housing the data in an archival solution has markedly different requirements than migrating data from an existing clinical application to another.
  • Retiring legacy systems typically do not necessitate changing the “shape” of the data to fit a particular model. A data archival solution facilitates legacy system retirement, providing a storage solution for clinical data archival in compliance with state and federal regulations for protected health information (PHI).
  • With EMR migration, data typically needs to be mapped and translated to facilitate proper import into the target system. This is critical for the clinical impact and workflow integration required to support a discrete clinical data migration.

Download the full archival whitepaper to evaluate available EMR data migration & EMR data archival options and processes critical to EMR replacement and legacy system decommissioning.

About Robert Downey
Robert is Vice President, Product Development, at Galen Healthcare Solutions. He has nearly 10 years of healthcare IT experience and over 20 years in Software Engineering. Robert is responsible for design and development of Galen’s products and supporting technology, including the VitalCenter Online Archival solution. He is an expert in healthcare IT and software development, as well as cloud based solutions delivery. Connect with Robert on LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Meaningful Use Has Done Its Job

Posted on September 19, 2016 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.

While Meaningful Use has been challenging at times, the vast majority of hospitals seem to have stayed on top of things. In its new report on the IPPS negative payment adjustments for fiscal 2017, CMS said that 98% of eligible hospitals and critical access hospitals managed to avoid Medicare payment dialbacks for next year, because they successfully attested to stage 1 or stage 2 Meaningful Use compliance, according to EHR Intelligence.

CMS began making Medicare payment adjustments on October 1, 2014 for eligible hospitals, of which there are more than 4,800 in the United States. The current adjustment will fall into place on October 1, 2016, as a reduction in the percentage increase to the Inpatient Perspective Payment System.

The negative payment adjustments to the IPPS now stand at 75%, up from 25% for the 2013 reporting period. Eligible hospitals had a chance to apply for hardship exceptions to the payment adjustments, though if they haven’t done so already it’s too late, as the window for seeking those exceptions for 2017 closed in April of this year. But as noted, few hospitals will be affected.

At this point, it’s worth taking time to stop and admire how this took place. Even when you consider that the feds handed lot a lot of money in incentives, this has all happened relatively quickly as IT investments go. Everyone likes to talk about how successful the banking industry was at rolling out interoperability with ATMs, but I doubt the backroom negotiations went any faster than the cascade of Meaningful Use attestations. In other words, Meaningful Use did its job.

After all, very few programs achieve close to 100% compliance under any circumstances. Even if providers face large government fines, no initiative is going to get 100% of the industry on board. So bringing 98% of eligible hospitals on board within a few scant years is an impressive achievement, particularly considering the healthcare industry’s record of foot dragging when it comes to new technologies.

Of course, the industry has clearly gone well beyond the need for Meaningful Use’s rather mechanical reporting requirements, valuable though they may have been as a training ground. So if we assume that Meaningful Use isn’t that, well, meaningful anymore, what’s next?

The answer is….drumroll…quality. Most hospitals will be focusing on the larger and more complex quality measurement demands imposed by the next generation of incentive payments proposed by CMS.

As many readers know, the Medicare Meaningful Use program for ambulatory is being rolled into the Merit-Based Incentive Payment System (MIPS), along with the Physician Quality Reporting System and Value-Based Modifier programs. beginning with the 2017 performance year.

Meaningful Use now has a new name in ambulatory care, Advancing Care Information, and strong performance on this measure can contribute up to 25% of the MIPS score a provider receives – or in other words, smart health IT deployment still counts. But that’s dwarfed by the 50% of the score contributed by strong quality performance.

This shift away from IT-specific performance measures is necessary and valuable. But as federal authorities lay out their new incentive programs, it’s worth giving good ol’ Meaningful Use a send-off. A job needed to be done, and however unsubtly, MU did it. We’ll see how quickly the MIPS program rolls over to replace MU in hospitals.

Bad Handwriting Could Cost a Doctor His License

Posted on September 16, 2016 I Written By

For the past twenty years, I been working with healthcare organizations to implement technologies and improve business processes for nearly twenty years. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

I admit that I don’t have very good handwriting. My signature is no better, and often leads people to ask if I am a doctor. Because it is commonly known that doctors don’t excel at handwriting skills. Thankfully, I rarely hand-write anything anymore. With computers, I can write quickly while still producing a result that is easy to read.

One benefit of an EHR solution is that we don’t have to worry about deciphering handwritting! But for one Nevada doctor, poor penmanship may lead to the loss of his medical license!

Read this story in the Review Journal for more information or this excerpt of the situation below:

The Nevada State Medical Board has formally threatened to revoke the medical license of Dr. James Gabroy, a 69-year-old Henderson internist who has never had malpractice or professional incompetence problems, nor has he ever had sexual misconduct, patient abandonment or fraudulent billing issues.

why is the board taking action against Gabroy — punishment ranges from a $5,000 fine to license revocation — with a Sept. 28 hearing scheduled in Reno?

His handwriting.

Citing confidentiality, Ed Cousineau, the board’s executive director, won’t stray far from the Oct. 23, 2015, board complaint that alleges the medical records of three unnamed patients were illegible, inaccurate and incomplete.

Are we heading for an environment where you’ll have to have an EHR in order to have a medical license?

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Study: Hospital EMR Rollouts Didn’t Cause Patient Harm

Posted on September 14, 2016 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.

Rolling out a hospital EMR can be very disruptive. The predictable problems that can arise – from the need to cut back on ambulatory patient visits to the staff learning curve to unplanned outages – are bad enough. And of course, when the implementation hits a major snag, things can get much worse.

Just to pull one name out of a hat, consider the experience of the Vancouver Island Health Authority in British Columbia, Canada. One of the hospitals managed by the Authority, which is embroiled in a $174 million Cerner implementation, had to move physicians in its emergency department back to pen and paper in July. Physicians had complained that the system was changing medication orders and physician instructions.

But fortunately, this experience is definitely the exception rather than the rule, according to a study appearing in The BMJ. In fact, such rollouts typically don’t cause adverse events or needless deaths, nor do they seem to boost hospital readmissions, according to the journal.

The study, which was led by a research team from Harvard, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, looked at the association between EHR implementation and short-term inpatient mortality, adverse safety events or readmissions among Medicare enrollees getting care at 17 U.S. hospitals. The hospitals selected for the study had rolled out or replaced their EHRs in a “big bang”-style, single-day go-live in 2011 and 2012.

To get a sense of how selected hospitals performed, the team studied patients admitted to the studied facilities 90 days before and 90 days after EHR implementation. The researchers also gathered similar data from a control group of all admissions during the same period by hospitals in the same referral region. For selected hospitals, they analyzed data on 28,235 patients admitted 90 days before the implementation, and 26,453 admitted 90 days after the EHR cutover. (The control size was 284,632 admissions before and 276,513 after.)

Apparently, researchers were expecting to see patient care problems arise. Their assumption was that in the wake of the go-live, the hospitals would see a short increase in mortality, readmissions and adverse safety events. One of the reasons they expected to see this bump in problems is that some negative problems related to time and season, such as the “weekend effect” and the “July effect,” are well documented in existing research. Surely the big changes engendered by an EHR cutover would have an impact as well, they reasoned.

But that’s not what they found. In fact, the researchers wrote, “there was no evidence of a significant or consistent negative association between EHR implementation and short-term mortality, readmissions, or adverse events.”

I was as surprised as the researchers to learn that EHR rollouts studied didn’t cause patient harm or health instability. Considering the immense impact an EHR can have on clinical workflow, it seems strange to read that no new problems arose. That being said, hospitals in this group may have been doing upgrades – which have to be less challenging than going digital for the first time – and were adopting at a time when some best practices had emerged.

Regardless, given the immense challenges posed by hospital EHR rollouts, it’s good to read about a few that went well.  We all need some good news!

10 Reasons for Full EHR Data Migration – Tackling EHR & EMR Transition Series

Posted on September 7, 2016 I Written By

top-10-reasons-for-ehr-data-migration

(Check Out the Full Top 10 Reasons for EHR Data Migration Infographic)

At Galen Healthcare Solutions we’ve found some important considerations and benefits during EHR data migration, including:

  • Legacy application licensing, and on-going support & maintenance.
  • Avoidance of data redundancy and improvement of data integrity.
  • Productivity and efficiency gains through enhanced clinical decisions support and consolidated clinical data access.
  • Enhanced regulatory reporting with programs including PQRS & PCMH.

When undertaking an EHR replacement project, there is a general misconception that the all of underlying patient clinical data is migrated systematically with ease. However, due to cost and complexity constraints, in most cases only patient demographics and basic clinical data elements are migrated to the new EHR system. In these cases, the legacy system is left operational in a read-only capacity; used as “system of record” for compliance, audits and responses for requests for information. Contrary to popular thought, this approach can actually end up being costlier than pursuing EHR data migration and archival, especially considering clinical efficiencies and patient care benefits associated with each of the latter.
legacy-ehr-data-migration
Understanding available EHR data migration & EHR data archival options and processes are vital to EHR replacement. Not doing so potentially leaves providers and staff inaccurate, unusable or missing data at go-live, compromising patient care. It’s important to evaluate scoping considerations, including options for import of discrete and non-discrete migrated data the new EHR systems provides, expertise of internal or external resources to migrate the data, and data retention requirements. Typically, the data elements & amount/duration of data to be migrated vs. archived is driven by organizational requirements related to continuity of care, patient safety, and population-based reporting requirements. Further, care needs to be taken to ensure data integrity when migrating clinical data – mapping nomenclatures and dictionaries where possible to avoid duplication, and facilitating reconciliation of the data to the existing chart in the target system.

At the heart of the EHR data migration process, it’s important that clinically driven workflows across various user roles are supported, transitioned, and maintained to the greatest extent possible. EHR data migration and archival allows for successful retirement of antiquated legacy applications, and ensures seamless and successful transition to the new EHR system.

Evaluate options, define scope and formulate a strategy for EHR data migration by downloading our EHR Migration Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Hospitals Can Learn From Low Outpatient EHR Turnover Rates

Posted on September 2, 2016 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.

According to new data from HIMSS, almost 80% of freestanding outpatient facilities have an EHR in place, a figure which has shot up 30% over the past five years. This is no big surprise, given that the growth tracks neatly with the Meaningful Use program run. What seems to take HIMSS analysts aback, on the other hand, is that only a scant 15% of outpatient facilities surveyed seem ready to replace or purchase an EHR,

Why are learned minds at HIMSS taken aback by this data? Well, for one thing, hospitals have set their expectations. And over the last couple of years, hospitals have been dumping their existing EHRs at a rapid pace, with many large hospitals switching to newer systems with population health capabilities.

A recent Black Book study suggests that many hospitals weren’t thrilled with the results of even their lastest EHR investment, with some even considering yet another switch. In other words, 2,300 hospital executives and IT staff interviewed weren’t seeing much benefit from their ongoing, massive investment of time and money.

What’s more, HIMSS analysts don’t seem to have taken a close look at how EHR purchasing patterns vary between the inpatient and outpatient setting. And that’s worth doing. After all, if outpatient buyers and inpatient buyers are making strikingly different decisions about how to spend on IT, the reasons for this disparity probably matter.

Important lessons

I don’t have any statistical data to back this up, but I do have a fairly straightforward theory on why hospitals seemingly do worse at investing in EHRs than outpatient facilities. I believe that EHRs are collapsing under the weight of trying to manage entire enterprises.

My sense is that outpatient EHR buyers aren’t just clinging to their existing systems due to inertia or lack of capital (though these factors doubtless come into play). Rather, they’re in a better position to take advantage of the systems they acquire than hospital IT departments.

For most medical groups, their mission is more straightforward and their management structure flatter than that of hospitals, which are having to be all things to all people of late. And this allows them to leverage an EHR more effectively.

To me, this suggests the following takeaways:

  • Hospitals might benefit from an EHR that’s focused more on supporting individual departments/service lines (including outpatient services) than a master enterprise system
  • If EHRs supported individual departments in a modular fashion, and the modules could be switched out between vendors, hospitals could update only the modules they needed to update
  • Hospitals could learn something from how their independent practice partners choose and integrate EHRs

Industry activity clearly suggests that CIOs back a more modular approach to solving clinical problems, and this could help them build a more flexible infrastructure that doesn’t get outmoded as quickly. And if outpatient buying patterns offer additional insights into decentralizing EHRs, it’d be smart to leverage them.

Thoughts On Hospital Telecommunications Infrastructure

Posted on August 31, 2016 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.

Given the prevalence of broadband telecom networks in place today, hospital IT leaders may feel secure – that their networks can handle whatever demands are thrown at them. But given the progress of new health IT initiatives and data use, they still might face bandwidth problems. And as healthcare technical architect Lanny Hart notes in a piece for SearchHealthIT, the networks need to accommodate new security demands as well.

These days, he notes healthcare networks must carry not only more-established data and voice data, but also growing volumes of EMR traffic. Not only that, hospital IT execs need to plan for connected device traffic and patient/visitor access to Wi-Fi, along with protecting the network from increasingly sophisticated data thieves hungry for health data.

So what’s a healthcare CIO to do when thinking about building out hospital telecommunications infrastructure?  Here’s some of Hart’s suggestions:

  • When building your network, keep cybersecurity at the top of your priorities, whether you handle it at the network layer or on applications layered over the network.
  • Use an efficient network topology. At most, create a hub-and-spoke design rather than a daisy chain of linked sub-networks and switches.
  • Avoid establishing a single point of failure for networks. Use two separate runs of fiber or cable from the network’s edge switches to ensure redundancy and increase uptime.
  • Use virtual local area networks for PACS and for separate hospital departments.
  • Segment access to your virtual networks – including your guest Wi-Fi service – allowing only authorized users to access individual networks.
  • Build as much wireless network connectivity into new hospital construction, and blend wireless and wired networks when you upgrade networks in older buildings.
  • When planning network infrastructure, bear in mind that hospital networks can’t be completely wireless yet, because big hardware devices like CT scans and MRIs can’t run off of wireless connections.
  • Bigger hospitals that use real-time location services should factor that traffic in when planning network capacity.

In addition to all of these considerations, I’d argue that hospital network planners need to keep a close eye on changes in network usage that affect where demand is going. For example, consider the ongoing shift from desktop computers to mobile devices use of cellular networks have on network bandwidth requirements.

If physicians and other clinical staffers are using cell connections to roam, they’re probably transferring large files and perhaps using video as well. (Of course, their video use is likely to increase as telemedicine rollouts move ahead.)

If you’re paying for those connections, why not evaluate whether there’s ways you could save by extending Internet connectivity? After all, closing gaps in your wireless network could both improve your clinicians’ mobile experience and help you understand how they work. It never hurts to know where the data is headed!

More Ideas On Tightening Hospital IT Security

Posted on August 29, 2016 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.

Security deserves all of the attention you can spare, and it never hurts to revisit the fundamentals, in part because the cost of lagging security measures is so high. After all, it’s more than likely that your organization will face a breach, as almost 90% of healthcare organizations experienced at least one breach within the past two years, according to a Poneman Institute study done earlier this year.

Here’s some options to consider when tightening up your security operations, courtesy of Healthcare IT Leaders, whose suggestions include the following:

Hire white hat hackers: Mayo Clinic reportedly tried this a few years ago, and learned a great deal. While its security measures seem to have gotten something of a beatdown, the Clinic also found a bunch of security holes and got recommendations on how to close those holes.

Lock down employee mobile devices: As mobile technology increasingly becomes a key part of your infrastructure, it’s important to keep it secured – but that can be tough when employees own the phone. One question to ask is whether your IT could lock or wipe data from employee phones and tablets if need be. What are your legal options for securing critical data on employee-owned devices?

Review medical device security:  Networked medical devices – from respirators and infusion pumps to MRI scanners – increasingly pose security threats, as any device that receives and transmits data can be a target for attackers.  It’s critical to audit these devices, while setting careful security standards for device makers.

Train staff on security issues:  Often, breaches are due to human error, so it’s critical to educate non-IT employees on the basics of security hygiene. Offering basic security training should cover not only cover ways to avoid security breakdowns – such as avoiding generic or default passwords and phishing e-mails — but also explanations of how such breaches affect patients.

Encourage risk reporting:  According to Poneman, almost half of healthcare organizations discovered a breach through an employee within the past two years. What’s more, nearly one-third of data breaches came to light due to patient complaints. It’s smart to encourage these reports, as IT staff can’t have eyes everywhere.

Disable laptop cameras and microphones:  Laptops generally come with a webcam and microphone, but at least in an enterprise setting, it may be better to disable these functions. Why? For one thing, attackers may be able to listen to private conversations through the microphone.

As I see it, the bottom line on all of these activities is to infuse security thinking into as many IT interactions as possible.  It may be trite to talk about a culture of security (it’s easier said than done, and too many organizations make empty promises) but such a culture can actually make a big impact on your security status.

To have the biggest impact, though, that culture has to extend all the way to the C-suite, and unfortunately, that rarely seems to happen. When I read research on how often healthcare organizations underspend on security, it seems pretty clear that many senior execs don’t take this issue as seriously as that should. And if the staggering level of health data breaches happening lately isn’t enough to scare them straight, I don’t know what will.