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The Challenge of Clinical Quality Measures – ONC Dashboard

The incomparable Mandi Bishop just pointed out to me an amazing ONC dashboard that’s tracking issues with the clinical quality measures (CQM). I don’t know how I’d never seen this before, but it’s a treasure trove of amazing information. I’m proud of ONC for being this transparent in their efforts to make the clinical quality measures as effective as possible.

It’s also an amazing illustration of how hard it is to get these clinical quality measures correct. As Mandi pointed out to me, Beta-blockers, for example, can’t be tolerated by Asian-Americans, but that’s a required CQM: prescribe beta-blockers within 24 hours of surgery for cardiac patients. That’s scary to think that a clinical quality measure could actually do harm versus improving quality.

We’ve heard this from doctors for a really long time. Medicine is complicated and each patient is unique. This dashboard illustrates many of those challenges.

Personally I think that the clinical quality measures were a step too far in the EHR incentive program. Although, I’ve long wished that all the incentive money would have been focused on establishing a standard for EHR interoperability and then paying organizations that were interoperable. That would do more impact for good on healthcare than these clinical quality measures.

What are your thoughts and experiences with clinical quality measures?

April 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Can We Learn Collecting System Data from How We Collect Medical Device Data?

We’ve been aggregating and sharing medical device data for a really long time in healthcare. Entire corporations are built around collecting and sharing medical device data with another healthcare IT system. If we’ve been able to share this data for so long, could we possibly learn from that experience and apply it to data collection and sharing in other health IT systems?

This is an open question which I hope you’ll join in answering in the comments of the blog. Many readers of this blog are more expert on this topic than I am. So, please chime in and add your thoughts. I think there is a real opportunity for us to learn from the past.

Here are a few of my thoughts:

Motivation – This is the biggest reason that medical device data collection and sharing happened. Organizations saw the value in having this data. I think we’re starting to see a shift in motivation when it comes to collecting system data in a healthcare organization as well. As I wrote about previously, we need data sharing as part of the Health IT procurement process. This will be a slow but important shift for many healthcare organizations. Otherwise you have lethal contracts that put huge financial barriers in the way of sharing data. ACOs and value based reimbursement will continue to motivate organizations to finally want to collect and share system data.

Standards – One of the benefits that device integration had was that there was more of a standard format for sharing the data. This is a lesson for other data system collection. We need a standard. Not a bunch of different flavors of standards, but a standard.

Multiple Standards – Some in the device space might argue that they had their own issues with standards. Every device company had their own standard and you had to integrate with each different device company. This depends on the device, but let’s just assume for a minute that this is indeed the case. How then were these organizations able to collect the medical device data? They just built up interfaces that understood each device’s standard. The key is that each company established a standard for their clinical device and stuck to that standard.

The challenge with other healthcare systems like EHR is that we have so many systems. Plus, even instances of the same EHR don’t follow the same standard. I’m not sure how to remedy this in the current EHR market, but it might be the key to us ever really collecting EHR data. I guess some would argue that market consolidation will help as well.

Connected Tech – One of the biggest challenges in the medical device space was having the technology in the medical device that allowed outside connectivity. Most new medical devices come with connectivity, but in the past you’d have to buy the connectivity separately and store it in a black box under the bed. This is a huge advantage for other healthcare IT software. The data is already connected to the internet.

Those are a few of my thoughts on what we can learn. I’d love to hear your thoughts.

April 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital EMR and EHR Recruiting

Late last year, I acquired the healthcare IT career website Healthcare IT Central. Since bringing Healthcare IT Central into the Healthcare Scene family, I’ve dove head first into the healthcare IT Recruiting and career space. It’s been quite an adventure with a lot of great learning for me along the way.

What I’ve learned most is that there are some really amazing people working in healthcare IT and some really amazing companies that are trying their best to make healthcare better. There are a lot of screwed up things in healthcare, but the people are generally good people and a real pleasure to work with.

Health IT Job Seekers
If you’re in the job market and looking for a healthcare IT job, take a few minutes to register as a job seeker where you can upload your resume and apply for jobs at some of the top healthcare IT companies. Also, be sure to check out some of these popular job searches:

Of course, you can always do your own health IT job search using the criteria that matter for you. All of this is all free for the job seeker.

Health IT Employers
If you’re a health IT company or a hospital organization looking to hire qualified healthcare IT professionals, you can register and post your jobs as well. We just passed over 20,000 registered job seekers and are getting close to 11,000 active health IT focused resumes.

We also have other options available to employers like eNewsletter sponsorships (almost 16,000 email subscribers), webinars, and resume database access where you can search for specific candidates.

We’re working really hard to be an amazing health IT career resource for both job seekers and employers. If you have any feedback on the site and what we’re doing, we’d love to hear it on our contact us page.

April 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Moving Hospital EHR to the Cloud

I’ve long been interested to see how hospitals were going to handle the shift to “the cloud.” Obviously, most hospitals have made a big infrastructure investment in huge data centers and so I’ve always known that the shift to the cloud would be slow. However, it also seemed like it was inevitable.

I was interested to hear Jason Mendenhall talk in our Healthcare Data Center Google Plus hangout about healthcare entities moving their technology infratructure into their data center. Plus, I pair that with the smaller rural hospital CIO I met who balked at the idea of having a data center or really even having any sys admin people on staff.

Plus, I’m reminded of this quote I heard Dr. Andy Litt tell me about when hospitals will start using Dell to host their Epic EHR:

The opportunity to host an Epic or other EHR is in first install, not for existing ones that have invested in a data center already. -Andy Litt, MD, Dell

I can’t imagine that many institutions really want to move their Epic EHR hosted locally into the cloud. That just doesn’t happen. At least it doesn’t right now. Will we see this change?

I think the answer to that is that we will see it change. There’s a really good argument to make that hospitals shouldn’t be building data centers and that there’s tremendous value to using an outside provider. Plus, many of these “data center” companies are becoming more than just a set of rails, power, and cooling. They are now working with a variety of cloud providers that can provide you more than just a place to put your own servers.

I’ll be interested to see how this plays out, but I think we’ll see fewer and fewer hospital data centers. The outside options and connectivity to those outside data centers is so good that there’s going to be no need to do it on your own.

March 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Are We Using All the Data We Have?

Many of you might remember the post I wrote previously about the real cause of hospital readmissions. In that post, I quote Stuart Long, Chief Marketing and Sales Officer at CapsuleTech, who shared with me some internal survey results. While I found those survey results really interesting Stuart also offered me a number of insights that I thought other might find interesting as well.

First, in our conversation Stuart commented off hand that “even in the hospital today we have to throttle the data we send them.” For some context, Stuart is referring to how much data the medical devices that Capsule connects to the hospital can send. Basically, he’s saying that these medical devices have a lot more data that they could share with the hospital, but the hospital IT systems can’t handle all the extra data.

I’m sure we could have a deep discussion of the value (or lack thereof) of the data that’s not being sent to the hospital systems. However, I think this is all part of a larger question we need to ask ourselves in healthcare. Are we using all the data that we have available to us? Maybe there is value in some of the data that the medical device is collecting and not transferring to the hospital IT system.

This topic also takes me to discussions around patient generated data. Millions of patients are tracking their health using hundreds of tracking devices. That’s a lot of data available for us to use. Are we using it? I can think of a few hospitals that have focused uses of this patient generated data. However, we certainly aren’t using the vast majority of this data.

Are We Using All the Data We Have? The answer is clearly no. The question then remains, should we be using more of the data that’s available to us? Should someone be responsible for making sure we’re using the data we have available to us the best way possible?

Another interesting insight that Stuart provided was that Capsule was looking to extend charting ability to point of care. For those who don’t know much background on Capsule, go and read medical device guru Tim Gee’s HIMSS 2014 blog post where he talks about them in some detail. When you think about the interfaces that Capsule has created for medical devices, they aren’t that much different than an interface between a charting application and the EHR. The big difference is that a medical device is capturing the data versus a human entering the data in the charting application. The method the data uses to become digital is irrelevant. After that it’s the same plumbing that gets that data to the EHR.

I’ll be interested to see how far they take this. One of my big topics of interest coming out of HIMSS 2014 was to dig deeper into the idea of external EHR interfaces. I heard about some huge teams that are creating generic EHR data interfaces that push the data to the EHR. I’ll be interested to see how far we go with this trend.

March 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Every Hospital Should Adopt EHR

While I’m sure this tweet will rub many the wrong way, I found it incredibly thought provoking. I have no idea who this person is that tweeted it, but I think that his tweet represents the majority of Americans who know very little about EHR and Health IT.

From a layman’s perspective, in every industry the use of IT has benefited that industry. Those not living in the EHR world just automatically think that by applying IT to something that we’ll see a huge benefit. Those of us in the EHR industry no doubt have a much more nuanced feeling about the benefits of EHR. I’m sure the guy who tweeted above won’t be happy with the meaningful use hardship exemptions which will defer organizations from being #finedheavily.

While I agree with the idea that we need broad EHR adoption, I think we have to be careful trying to rush any EHR implementation. A rushed EHR implementation is far worse than no EHR.

March 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Cerner Agrees To Pay $106M Over Allegedly Defective Software

After years of back and forth, Cerner has settled a dispute with a North Dakota hospital claiming that Cerner’s financial software was defective and didn’t deliver expected business benefits.

Back in April 2012, Trinity Health told the vendor that it was transitioning away from Cerner’s patient accounting software solution and certain IT services provided by Cerner. At the time, it alleged that the patient accounting solution didn’t work right.  Of course, Cerner disputed the allegations, according to its 10-K yearly report.

The two players began arbitration in December 2013, a move which allowed Cerner to collect some payments due from the hospital.  At the outset, Cerner was predicting liability you of up to $4 million, while Trinity anticipated damages totaling $240 million.

Ultimately, the two agreed upon a settlement under which Cerner would pay Trinity $106 million. Interestingly, Trinity is continuing as a client of Cerner for its clinical solutions, something you might not expect under the circumstances.

This is a particularly unusual outcome for a vendor/hospital dispute, because most vendor contracts contain clauses to eliminate “consequential damages,” which limit hospital’s ability to take legal action, notes Trinity attorney Michael Dagley. That being said, there are areas under state and common law provisions of consumer fraud statutes, under which manufacturers cannot misrepresent product capabilities and benefits.

Knowing how hard it is for a hospital to sue a vendor of IT services, it makes you wonder whether the growing number of hospitals dumping their current EMR are doing so because they’re not getting what they want but can’t sue to get their money back.  While it may be heinously expensive, buying a new EMR and installing it is certainly faster than going through years of court proceedings and then having to buy another EMR nonetheless.

March 12, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Is IT The Reason CEO Turnover Is So High?

A new study from the American College of Healthcare Executives reports that hospital CEO turnover increased to 20 percent in 2013, the highest rate reported since ACHE began tracking these numbers in 1981.

There are several reasons one could identify as causes for high CEO turnover, including the retirement of baby boomers and the trend towards consolidation in the industry, which may eliminate jobs.

All that being said, I believe that the most likely reason for high CEO turnover of late is the turmoil around IT, including but not limited to evaluating and buying equipment from EMR vendors, managing process changes as the EMR is installed, seeing to it that the EMR doesn’t bankrupt the hospital and more.

And then, there is a need for management to be responsible for all of the systems that feed into the EMR, and to do something with the data that they produce.

Bottom line, it’s hardly surprising that there are a record number of CEOs struggling to stay on top of the crest where IT is concerned.  And it’s also not too surprising that some CEOs, who had done very well as the responsible leader with their hands on the wheel, might be less suited to the massive changes that can occur in the wake of IT transformation.

No, in reality it’s not very surprising that this is a time of high turnover for CEOs.  When you pile on the various revolutions taking place in healthcare IT, and the need to lead your staff through them, manage them and prepare for the future, you have what might be seen as an impossible job for some CEOs. It’s not a big surprise that particularly high number of hospital CEOs are calling it a day — or having it called for them.

March 11, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Over-hyped and Under-Delivered Tech According to Hospital CIOs


This is an interesting list:
#BigData
#EHR
#Cloud
#GoogleGlass
#ACO

When you think about the future of health IT, all of these except for Google Glass are guaranteed to be a major role in health IT. The use of data in healthcare is not going anywhere. EHRs will be the foundation of health IT for a long time to come. The move to cloud computing is happening everywhere in healthcare. ACOs are heading are way and I see nothing that will do anything to stop them. Google glass is the only thing on the list that might fizzle, but what Google glass represents (always on, always connected computing) won’t go anywhere.

Does health IT have a PR image issue?

March 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Eyes Wide Shut Meaningful Use Series

For those of you who read Hospital EMR and EHR but don’t read EMR and HIPAA (which from our latest survey is far too many of you), I wanted to highlight a series of blog posts by Mandi Bishop that I believe will be of extreme interest to those reading this site.

In this series called Eyes Wide Shut, Mandi gives some really amazing in the trenches views into how a large organization is dealing with the challenges of meaningful use and meaningful use stage 2 in particular.

Here’s a small sample from the latest entry in the series titled “Eyes Wide Shut: Meaningful Use Stage 2 Incentive Program Hardships“:

In my January update on Meaningful Use Stage 2 readiness, I painted a dismal picture of a large IDN’s journey towards attestation, and expressed concern for patient safety resulting from the rush to implement and adopt what equates to, at best, beta-release health IT. Given the resounding cries for help from the healthcare provider community, including this February 2014 letter to HHS Secretary Kathleen Sebelius, I know my experience isn’t unique. So, when rumors ran rampant at HIMSS 2014 that CMS and the ONC would make a Meaningful Use announcement, I was hopeful that relief may be in sight.

Like AHA , I was disappointed in CMS Administrator Marilyn Tavenner’s announcement. The new Stage 2 hardship exemptions will now include an explicit criteria for “difficulty implementing 2014-certified EHR technology” – a claim which will be evaluated on a case-by-case basis, and may result in a delay of the penalty phase of the Stage 2 mandate. But it does nothing to extend the incentive phase of Stage 2 – without which, many healthcare providers would not have budgeted for participation in the program, at all, including the IDN profiled in this series. So how does this help providers like mine?

In that post, Mandi also tries to not just complain about the challenges they face, but also offer some solutions. You can see her full list of ideas in the post, but I especially like the simplicity of her last line “Consider applying the hardship exemption deadline extension to the incentive program participants.”

We need more in the trenches people like Mandi sharing their stories and solutions for others to see. Otherwise, the regulators sit in their office in DC and don’t know the details of why they should adjust. If you’re someone reading this that would like to tell your story as well, I’d be happy to give you the platform. Just drop me a note on our contact us page.

March 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.