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Another Look At Easing EMR Adoption Problems

Posted on July 22, 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.

Though EMRs are no longer a brand-new thing, rolling them out is still a difficult challenge for hospitals. After all, even the best platforms can require significant changes in staffers’ day-to-day work, which isn’t easy for anyone. And some less technology-savvy workers may struggle to pick up new routines. Plus, we’re still seeing a lot of EMR implementations as hospitals switch EHR vendors, EHR vendors get sunset, and hospitals get acquired by larger hospitals with different EHR.

So I was interested to read yet another take on how hospitals can survive this tumultuous period. This one comes from Next Services, an Ann Arbor, MI-based health IT software and consulting firm. Here’s some of the more interesting steps Next Services offers to help smooth out the adoption process:

  • Have managers create a 3×3 matrix sorting key players by skill and resistance. Along the top, divide the rows into high, medium and low skill sets, then along the left side, label three columns for high, medium and low resistance levels. Sorting workers into categories such as high skill/low resistance, high skill/high resistance, low skill/high resistance and so on can help managers predict what issues will arise for individual workers.
  • Roll out EMR in modules rather than phases, and don’t go to the next set of modules until you and your team are hundred percent confident that everyone can use them. Also, start with core modules that help document the basic chart, then expand outward to modules with greater functional depth.
  • Prepare staff for crises. Think through all of the ways that the rollout could go wrong during live patient care use, and make sure staffers are prepared to react appropriately when such an event happens.
  • Think of the rollout as a game. To encourage staffers, offer points for important factors such as knowledge, helpfulness and speed. Then put a chart presenting the results on a big monitor for everyone to review at the end of the day.
  • Celebrate your successes. Celebrating small wins with the staff during the rollout can help keep the atmosphere positive. Celebrations can be anything from an ice cream social to a simple group cheer.

While I find these suggestions to be interesting and useful, I’d love to see a companion list providing suggestions on how hospitals and health systems can help staffers cope with a second or third EMR rollout. My guess is that such a transition poses different management challenges than pulling the switch the very first time.

As I see it, such implementations could range from toxic (staff was exhausted by the first rollout and doesn’t want to play this time) to comparatively easy (staffers learned a lot the first time, and find additional changes to be less upsetting than they did the initial go-live). And obviously, much will depend upon how the next implementation is managed, how training is presented and how the previous rollout went.

Still, there must be ways to ease the blow regardless. What suggestions would you have for health IT leaders who are navigating their second or more EMR rollout?

E-Patient Update: Hospitals Need Virtual Clinicians

Posted on July 20, 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.

Hospitals have a lot to lose if patients are readmitted not long after discharge. But in most cases, their follow-up care coordination efforts post-discharge are perfunctory at best.

My husband’s experience seems to be typical: a few weeks after his discharge, a nurse called and asked perhaps five or six very broad questions about his status. I doubt such as superficial intervention has ever done much prevent a patient from deteriorating. But this dynamic can be changed. As an active, involved e-patient, I think it’s time to bring artificial intelligence technology into the mix.

In recent times, AI platforms have emerged that may offer a big improvement on the, well, largely nothing hospitals do to prevent patients from deteriorating after they leave the facility. In fact, artificial intelligence technology has evolved to the point where it’s possible to provide a “virtual clinician” which serves as a resource for patients.

One example of this emerging technology comes from AI startup Sense.ly, which has developed a virtual nurse named Molly. According to the company, Molly is designed to offer customized patient monitoring and follow-up care, particularly for patients with chronic diseases. Its customers include the UK’s National Health Service, Kaiser Permanente, San Mateo Medical Center, University of California San Francisco, Microsoft and Allscripts.

Molly, an avatar-based system which was designed to mimic the bedside manner patients crave, can access data to assist with real-time care decisions. It also monitors vital signs – though I imagine this works better with a remote connected device — and tracks patient compliance with meds. Molly even creates custom questionnaires on the fly to assess patients, analyzes those responses for risk, and connects patients directly to real- life clinicians if need be.

While this is admittedly a groundbreaking approach, some independent research already exists to suggest that it works. Back in 2011, Northeastern University researchers found that patients who interacted with virtual nurse Elizabeth were more likely to know their diagnoses and make follow-up appointments with their doctor, ZDNet reports.

And if you’re afraid that using such a tool exposes your facility to big legal risks, well, that’s not necessarily the case, according to veteran healthcare attorney David Harlow.

“The issue is always in the terms of use, and if you frame that properly – and build the logic properly – you should be OK,” Harlow told me. He concedes that if hospitals can be sued for patient care problems generated by EMR failures — which happens now and then — a cause of action could arise from use of virtual clinician. But my sense from talking with him was that there’s nothing inherently more dangerous about deploying an AI nurse than using any other technology as part of care.

Speaking for myself, I can’t wait until hospitals and medical practices deploy a tool like Molly, particularly if the alternative is no support at all. Like those who tested Elizabeth at Northeastern University, I’d find it much easier to exchange information with an infinitely patient, focused and nonjudgmental software entity than a rushed nurse with dozens or hundreds of other patients on their mind.

I realize that I’m probably ahead of the market in my comfort with AI technology. (My mother would have a stroke if you asked her to interact with a virtual human.) But I’d argue that patients like me are in the vanguard, and you want to keep us happy. Besides, you might be pleasantly surprised by the clinical impact such interventions can have. Seems like a win-win.

Hospitals Struggle To Use EHRs To Report eCQMs

Posted on July 18, 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.

A new study by CMS has found that hospitals are struggling to use their EHRs to report electronic clinical quality measures. The agency found that while EHRs helped contractors collect data remotely using hospital staffers, EHR platforms “had not yet matured” enough to meet the specs required, according to Managed Care magazine.

The CMS findings came from a validation pilot study of eCQMs. The goal of the pilot study was to evaluate approaches for validating eCQMs for the Hospital Inpatient Quality Reporting program.

The program, which was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, authorized CMS to pay hospitals a higher annual update to their payment rates if they successfully reported designated quality measures. Later legislation mandated that Medicare hospitals that don’t successfully report would be hit with a 2.0% reduction in the annual rate of inflation used to calculate payment.

One might guess that putting EHRs in place would help hospitals comply. But it appears that this is not been the case in many instances. In fact, hospital IT leaders are facing some significant challenges in linking EHR data to the required reporting format.

To accurately report eCQMs, hospitals must create complete and accurate Quality Reporting Data Architecture (QRDA)-I files based on 2014 eCQM specifications. But hospitals reported that they were having a hard time mapping the information in the EHR systems to the QRDA-I specifications, particularly given the use of unstructured data fields and multiple source of information for various events, Managed Care reported. Measures match rates, in turn, were rather low, ranging from 12% to 49%.

The hospitals involved in the pilot also said that data mapping and workflow issues were major problems. For example, as it turned out much of the information they needed was locked up in free text, notes or scanned documents rather than discrete data fields. That made it impossible for those hospitals to extract the data and mapping to the elements found in the QRDA-I files.

To solve these problems, pilot hospital reported, CMS should consider addressing three key areas: boost communication, outreach and education to raise hospital and vendor understanding of eCQMs; cut down the burden imposed by eCQM adoption; and offer tools and guidance to help hospitals with eCQM implementation.

As CMS learns, the help hospitals want should be forthcoming. In the report, CMS said that it plans to conduct additional validation pilots in the future. The agency said its goal will be able to help hospitals and vendors transition to eCQM reporting, and over time to increase the accuracy of the data that gets reported.

Are We Outgrowing HIM Systems?

Posted on July 15, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

We have changed and adapted to a rapid influx of electronic medical records and data over the last several years and it’s no surprise that some systems have struggled to keep the pace. Electronic medical records (EMRs) are in a state of constant revision to make sure patient care, clinical functionality, and data security measures are keeping up with our needs. It seems there are software application solutions or enhancements to almost every task we do in healthcare and these systems are also constantly evolving.

I don’t know of any healthcare application system or workflow that has remained static year over year and because of this, it is important for us to stay on top of vendors and keep an eye on current and future needs of HIM workflows. Clinical Documentation Improvement (CDI) is one of those areas that has been evolving since it first came on the scene and it is currently undergoing yet another face-lift. We realized there were many revenue opportunities hiding within inpatient clinical documentation and found that we could maximize reimbursement with a little detective work and physician education along with sophisticated software tools. Many are exploring the idea of CDI for outpatient levels of care. This means we will need software applications, interfaces, and expanded CDI workflows to extend these opportunities to outpatient documentation. Have you thought about what you will need from your vendors to adapt or upgrade current systems and how much will need to be budgeted for?

As we work to implement computer assisted coding (CAC) programs, we see opportunities to increase coder and CDI productivity and capture even more quality documentation by using discrete EMR data to our advantage. But are these CAC systems ready to be pushed to the limits to enter unchartered waters? I personally do not have a CAC success story to tell as of yet, but I am exploring the options and hoping that these systems have matured more than when we first explored them a few years ago.

That’s the beauty of technology in healthcare; if a product does not meet your needs, there may be other options already on the market or rapidly developing new technologies on the horizon. A vast amount of data may be held hostage in our systems if we do not maximize our EMRs and applications and set our standards high in a quest for knowledge. We can’t rely 100% on technology to dictate what we do which is why we need to be the visionaries and demand more from our systems in order to accomplish new and exciting things in HIM.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

EMR Lawsuit – A Taste Of Things To Come

Posted on July 13, 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.

A central Pennsylvania health system is embroiled in a court fight with Cerner amid allegations that its EMR technology has created serious patient care problems that could have led to serious harm.

PinnacleHealth, a three-hospital system based in Harrisburg, PA, is blaming series of patient care problems on its Siemens health IT technology, which was acquired by Cerner in February 2015. Apparently, PinnacleHealth had used Siemens as a vendor for 20 years, but when it grew dissatisfied with the platform, cut back its relationship with Siemens and signed a contract with Epic.

Last year, Cerner responded to PinnacleHealth’s actions with a breach of contract lawsuit, asserting that the health system hadn’t paid for services since February 2015. The suit claims that Pinnacle now owes Cerner more than $20 million.

PinnacleHealth, in turn, filed a counterclaim earlier this year in Pennsylvania state court, which seeks damages for Cerner’s alleged fraud and breach of contract. In the counterclaim, it cited several instances of problems it contends were caused by the EMR, including a case in which one patient’s blood pressure dropped dramatically after he was allegedly discharged the wrong medications. It also cites an instance in which a doctor was unable to place a pharmacy order for a newborn to receive vitamin K, a standard step taken to protect babies from serious bleeding.

While some experts are positioning this as the first of a growing number of EMR-related safety disputes, I’d argue that there’s other big issues in play which are more important to consider.

First, though it’s possible the Siemens EMR had problems, it’s impossible to know whether that had more to do with the customer’s unique IT set-up or whether there was an actual tech failure.

That being said, it’s also possible that Cerner missed something during its buyout of Siemens, a risk every vendor who acquires a technology company takes. And EMR vendor consolidation is continuing. If the acquiring vendors move too quickly, or have trouble integrating the new technology into their existing fold, will a growing number of clear-cut cases of EMR failure occur?

Also, it’s important to note that PinnacleHealth is currently battling the FTC for permission to merge with Penn State Hershey Medical Center. Clearly, it needs to have technology in place which can scale and isn’t burdened by 20 years of legacy adoption if the merger goes forward. Admittedly, Penn State Hershey is a Cerner shop, not Epic, but who knows what Penn State Hershey has in mind for HIT if it does get to close the deal?

Yes, there will be some product liability litigation over alleged EMR failures. And in some cases, particularly given the ongoing M&A activity among vendors, someone will drop the ball and bad things will probably happen.

But the most important thing I see happening here is the death knell for older systems in the wake of industry consolidation. I’d keep an eye on mergers between health systems and acquisitions by EMR vendors. Those are the forces that will dictate what happens in the HIT world going forward.

McKesson Merges Division With Change Healthcare

Posted on July 11, 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.

McKesson Corp. has announced plans to roll the majority of its Technology Solutions business into an independent organization, combining the assets with those of Change Healthcare. McKesson will co-own the new company with Change. Once the deal is complete, execs plan to take the new company public, probably sometime next year.

According to McKesson CEO John Hammergren, the two companies came together to offer a better range of options to providers. “The new company will establish a more efficient suite of end-to-end payment and claims solutions, as well as clinical capabilities,” Hammergren said in a company announcement.

The new entity, which combines most of the Technology Solutions assets with the bulk of the former Emdeon, will have combined total annual revenues of $3.4 billion. When the deal is done, McKesson will own about 70% of the new company, with the remainder held by Change Healthcare stockholders.

McKesson will still hold on to RelayHealth Pharmacy and its Enterprise Information Solutions division for now, but is looking at “strategic alternatives” for the EIS division. Change Healthcare, for its part, is keeping its pharmacy switch and prescription routing businesses, which will continue to be held by the current Change stockholders.

The deal could wring new profits out of a McKesson division which has seen better days, observers say.

The last few years have been tough for McKesson which, as HIStalk notes, has seen a growing number of customers going is technology aside in favor of Epic and Cerner solutions. Four years ago, the vendor began shifting resources away from its Horizon Clinicals product line in favor of its Paragon suite. Horizon had been serving several hundred large facilities of 300 beds and up. Since then, McKesson has struggled to convert Horizon customers to Paragon, as gossip heated up that the Atlanta vendor was dialing down Horizon support to force customers onto Paragon.

Now, execs hope the combined company will offer the resources, scalability and integration hospital customers are after. The question is whether even such a large player can challenge Epic and Cerner’s stranglehold on the hospital market. If nothing else, it will have to battle perceptions that it can’t offer the best tool for the larger hospital systems, HIStalk points out.

Still, even if it doesn’t win Epic or Cerner shops, leaders of the news spun-off entity expect to cast a wider net. Execs hope combined set of financial and payment solutions the attractive to help plan as well as providers.

$34.7 Billion Spent on Meaningful Use

Posted on July 8, 2016 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.

CMS has put out the latest data on meaningful use participation and payments. They broke the Medicare dollars out by meaningful use stage 1 and stage 2. Meaningful use stage 1 cost nearly $20 billion. Meaningful use stage 2 cost $3.4 billion. The amounts were less for stage 2, but that’s still a massive drop off.

Less than half of eligible providers participated in stage 2 that participated in stage 1 (308k compared to 145k). Participating hospitals dropped from 4600 hospitals to 3096. This illustrates well what we’ve been saying for a while as far as hospitals still largely participating in meaningful use and most doctors choosing not to participate.

Also interesting to note is that at its peak, meaningful use was paying about $10 billion per year. In 2015, they spent $2.8 billion.

What I didn’t see in this report was any numbers on the cost savings that the meaningful use program provided. All the OIG estimates for meaningful use talked about how much money would be spent, but they also calculated how much money would be saved as well. As I recall they estimated about $36 billion in spending, but about $16 billion in savings. That would put the cost of the meaningful use program at $20 billion instead of the full $36 billion which it looks like we’ve now pretty much spent.

I like that HHS puts out this accountability as far as where the meaningful use money was spent. Shouldn’t we have some accountability as far as the savings as well? Do they not have a way to calculate it? Are they afraid that there weren’t cost savings? Or that meaningful use actually added costs? Maybe it’s in another report and I just missed it. If you know of that other report, I’d love to see it.

What do you think of these numbers? What’s been the benefit of the $34.7 billion that’s been spent? I’d love to hear your thoughts in the comments.

Data Sharing Largely Isn’t Informing Hospital Clinical Decisions

Posted on July 6, 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.

Some new data released by ONC suggests that while healthcare data is being shared far more frequently between hospitals than in the past, few hospital clinicians use such data regularly as part of providing patient care.

The ONC report, which is based on a supplement to the 2015 edition of an annual survey by the American Hospital Association, concluded that 96% of hospitals had an EHR in place which was federally tested and certified for the Meaningful Use program. That’s an enormous leap from 2009, the year federal economic stimulus law creating the program was signed, when only 12.2% of hospitals had even a basic EHR in place.

Also, hospitals have improved dramatically in their ability to share data with other facilities outside their system, according to an AHA article from February. While just 22% of hospitals shared data with peer facilities in 2011, that number had shot up to 57% in 2014. Also, the share of hospitals exchanging data with ambulatory care providers outside the system climbed from 37% to 60% during the same period.

On the other hand, hospitals are not meeting federal goals for data use, particularly the use of data not created within their institution. While 82% of hospitals shared lab results, radiology reports, clinical care summaries or medication lists with hospitals or ambulatory care centers outside of their orbit — up from 45% in 2009 — the date isn’t having as much of an impact as it could.

Only 18% of those surveyed by the AHA said that hospital clinicians often used patient information gathered electronically from outside sources. Another 35% reported that clinicians used such information “sometimes,” 20% used it “rarely” and 16% “never” used such data. (The remaining 11% said that they didn’t know how such data was used.)

So what’s holding hospital clinicians back? More than half of AHA respondents (53%) said that the biggest barrier to using interoperable data integrating that data into physician routines. They noted that since shared information usually wasn’t available to clinicians in their EHRs, they had to go out of the regular workflows to review the data.

Another major barrier, cited by 45% of survey respondents, was difficulty integrating exchange information into their EHR. According to the AHA survey, only 4 in 10 hospitals had the ability to integrate data into their EHRs without manual data entry.

Other problems with clinician use of shared data concluded that information was not always available when needed (40%), that it wasn’t presented in a useful format (29%) and that clinicians did not trust the accuracy of the information (11%). Also, 31% of survey respondents said that many recipients of care summaries felt that the data itself was not useful, up from 26% in 2014.

What’s more, some technical problems in sharing data between EHRs seem to have gotten slightly worse between the 2014 and 2015 surveys. For example, 24% of respondents the 2014 survey said that matching or identifying patients was a concern in data exchange. That number jumped to 33% in the 2015 results.

By the way, you might want to check out this related chart, which suggests that paper-based data exchange remains wildly popular. Given the challenges that still exist in sharing such data digitally, I guess we shouldn’t be surprised.

The Rise of the “EHR Value” Equation at Hospitals

Posted on July 1, 2016 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 heard a lot of people talk about how it will be impossible for ambulatory EHR vendors like athenahealth and eCW to break into the acute care market. For those following along at home, both companies have announced that they’re building out their EHR software for the acute care market. These are big bets by both companies, but I think many people don’t realize the advantage these companies will have going into the very expensive hospital EHR market.

Companies like eCW and athenahealth will be able to come into a hospital with a native cloud platform that will let them offer some really aggressive pricing. When you’re paying $50+ million for an EHR (or $9+ billion for some), there’s a lot of wiggle room for a new entrant to enter the fray at a much lower cost point. That lower cost point will totally change the EHR value equation for hospitals. In fact, these cloud based hospital EHR will likely be able to compete effectively against a legacy EHRs upgrade costs alone.

Don’t believe this is possible? Take a look at the story about Delta Regional Hospital returning to MEDITECH. Why did they do it? Thomas Moore, vice president and CFO at Delta said, “We were looking for a system with a lower cost of ownership without sacrificing quality.” Moore later added this comment, “MEDITECH is a company that truly understands the meaning of value.”

During the wild west phase of EHR where the industry was propped up by $36 billion in stimulus money, everyone had the perfect rationale for spending hundreds of millions (and even billions) on EHR software. As we return to a more rational market we’re going to see hospital CIOs starting to place a much larger emphasis on EHR value. Showing that value is going to be hard for some of the larger EHR vendors who’ve charged hundreds of millions and even billions of dollars to their customers. Plus, it will be hard for them to lower their price.

In one online thread I participate on, a bunch of people were bashing Delta Regional Hospital’s decision to go back to MEDITECH. However, a former CIO offered this great insight:

Ya gotta spend time in a Meditech shop. It’s not flashy, but from a value perspective (and it does a lot more than just EHR), it’s hard to beat.

The same is going to be true with acute care EHR from eCW and athenahealth, but they’ll have some of the sexy factor as well. In the acute care EHR world I believe we’re just entering the new world of EHR value. Those who can tell the story of the value they’ve created for customers are going to win. Plus, we’re going to see a fierce battle from new entrants who are going to try and undercut the market. Think about how the EHR value equation changes when you can charge even $75 million instead of $100 million. That’s a game changer.

Hospital Accused Of Firing Nurse For EMR Safety Complaints

Posted on June 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.

The former chief nursing officer of a California hospital is suing her former employer, alleging she was “forced out” of her position after questioning the safety of a little-known EMR donated by a major financial backer of the facility.

The suit filed by nurse Autumn AndRa also names Dan Smith, whose company donated the Harmoni software now used by Sebastopol, CA-based Sonoma West Medical Center. AndRa is claiming that Smith, who has contributed millions in donations and loans to the hospital, has used the hospital as a test bed for his company’s defective system. Smith is president of the medical center’s board of directors.

In an interview with a local newspaper, AndRa said that the Harmoni system has had major problems since the day it went live. Among other issues, the EMR was doing a poor job tracking and updating medications and was “intermingling” medical information between patients, her suit contends. According to AndRa, she went to hospital CEO Ray Hino a week before her dismissal and told him that the system was not safe. (Hino told the newspaper that Harmoni was fine and that no patients had been harmed by the system.)

E-Health Records International Inc., which makes the cloud-based system, primarily serves hospitals outside the U.S., including facilities in the Congo, Jamaica, India and the Philippines. Smith, whose first software development success came when he sold a construction management system to Intuit, serves as the company’s CEO, as well as chairman of telemedicine firm Offsite Care Resources.

Other than that, he seems to have little documented experience as an HIT developer. His other major business venture seems to have been operating a French restaurant with his wife, which he closed after being unable to get back $5.8 million he loaned the hospital.

Regardless of whether AndRa prevails in her suit, I think it’s safe to say that she came out on the wrong end of some questionable political maneuvering by hospital leaders, perhaps including Smith himself. When a hospital is forgiven a large loan, and then fires an executive who raises safety questions about the EMR developed by the lender, eyebrows should be raised.