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Fall 2014 Health IT Conference Schedule

Posted on September 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Going to my third conference in a week must mean that we’re in the heart of Fall health IT conference season. This week I’m at AHIMA. I love attending AHIMA. I think that the AHIMA conference is a bit like HIM staff in general. There this hidden gem that many people don’t recognize even though they have tremendous value. I feel the same at this conference. The HIM staff at AHIMA have some really great perspectives on what’s happening with healthcare IT in their organization. I don’t think it’s a must attend event for everyone, but it’s great for a blogger like me to get a variety of perspectives on the healthcare IT industry.

This is really just the start of the conference season for me. I always get asked by people which conferences they should attend. In fact, my breakfast meeting this morning with a new to healthcare vendor this morning had a lot of discussion about which health IT conferences they should attend. For those interested in this same question, I’ve created a page which lists the Health IT Conferences I’m attending and also a look at some of the major health IT conferences that happen every year.

As I’ve talked to people, I’ve realized there are a few other events that I need to add to the list. I like to joke with people that if I wanted to I could attend a different health IT event every day of the week. Although, that’s not really much of a joke since it’s basically true.

What events do you attend? Which ones do you find most valuable?

From a hospital IT perspective, the CHIME Fall Forum is the tops for me. The Digital Health Conference is good and hospital CFO’s should hit the Craneware Summit. Then, of course, HIMSS is a great place for hospital IT people, but that’s not until April 2015.

I’m looking forward to all these conferences. They provide me a lot of perspective which I use in all of my blog posts. If you’re going to be at any of the events, let me know. I always love to meet readers in person.

ACOs Stuck In Limbo In Trying To Build HIT Infrastructure

Posted on September 26, 2014 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 they try to present themselves differently, ACOs are paper tigers. While they may be bound together by the toughest contracts an army of lawyers can devise, they really aren’t integrated in a meaningful way.

After all, the hospitals and medical groups that make up the ACO still have their own leadership, they don’t generally hold assets in common other than funds to support the ACO’s operations, and they’re definitely not in a great position to integrate technically.

So it comes as no surprise that a recent study has found that ACOs are having a hard time with interoperability and rolling out advanced health IT functions.

The study, a joint effort by Premier and the eHealth Initative, surveyed 62 ACOs. It found that 86% had an EMR, 74% had a disease registry, 58% had a clinical decision support system, and 28% had the ability to build a master patient index.

Adding advanced IT functions is prohibitively difficult for many, researchers said. Of the group, 100% said accessing external data was difficult, 95% said it was too costly, 95% cite the lack of interoperability, 90% cite the lack of funding or return on investment and 88% said integration between various EMRs and other sources of data was a barrier to interoperability.

So what you’ve got here is groups of providers who are expected to deliver efficient, coordinated care or risk financial penalties, but don’t have the ability to track patients moving from provider to provider effectively. This is a recipe for disaster for ACOs, which are having trouble controlling risk even without the added problem of out of synch health IT systems.

By the way, if ACOs hope to make things easier by merging with some of the partners, that may not work either. The FTC — the government’s antitrust watchdog — has begun to take a hard look at many hospital and physician mergers. While hospitals say that they are acquiring their peers to meet care coordination goals, the FTC isn’t buying it, arguing that doctors and hospitals can generally achieve the benefits of coordinated care without a full merger.

This leaves ACOs in a very difficult position. If they risk the FTC’s ire by merging with other providers, but can’t achieve interoperability as separate entities, how are they going to meet the goals they are required to meet by health insurers? (I think there’s little doubt, at this point, that truly successful ACOs will have to find a way to integrate health IT systems smoothly.)  It’s an ugly situation that’s only likely to get uglier.

EMR Change Cuts Cardiac Telemetry Use Substantially

Posted on September 25, 2014 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.

Changing styles of medical practice can be really tough, even if major trade organization sticks its oar in to encourage new behavior from docs.

Such is the situation with cardiac telemetry, which is listed by the American Board of Internal Medicine Foundation as either unnecessary or overused in most cases. But a recent piece of research demonstrated that configuring an EMR to help doctors comply with the guideline can help hospitals lower needless cardiac monitoring substantially.

Often, it takes a very long time to get doctors to embrace new guidelines like these, despite pressure from payers, employers and even peers. (Physicians may turn on a dime and try out a new drug when the right pharmaceutical rep shows up, but that’s another story.) Doctors say they stick to their habits because of patient, institutional or personal preferences, as well as fear of lawsuits.

But according to a recent study appearing in JAMA Internal Medicine, reprogramming its Centricity EMR did the trick for Wilmington, Del.-based Christiana Care Health System.

To curb the use of cardiac telemetry that was unnecessary, Christiana Care removed the standard option for doctors to order cardiac monitoring outside of AHA guidelines, and required them to take an extra step to order this type of test.

Meanwhile, when the cardiac monitoring order did fall within AHA guidelines, Christiana Care added an AHA-recommended time frame for the monitoring. After that time passed, the EMR notified nurses to stop the monitoring or ask physicians if they believed it would be unsafe to stop.

The results were striking. After implementing the changes in the EMR, the health systems average daily not intensive care unit patients with cardiac monitoring fell by 70%. What’s more, Christiana Care’s average daily cost of administering  non-ICU cardiac monitoring held by 70%, from $18,971 to $5,772.

Christiana Care’s health IT presence is already well ahead of many hospitals — it’s reached Stage 6 of the HIMSS EMRAM scale — so it’s not surprising to see it leading the way in shaping physician behavior.

The question now is how the system builds on what it’s learned. Having survived a politically-sensitive transition without creating a revolution in its ranks, I’d argue the time is now to jump in and work on compliance with other clinical guidelines. With pressure mounting to deliver efficient care, it’d be smart to keep the ball rolling.

Is No Flex-IT the Best thing for EHR and Healthcare?

Posted on September 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Strategically placed during National Health IT Week, 17 healthcare organizations sent a letter to HHS requesting that the meaningful use reporting period for 2015 be adjusted from 365 days to 90 days. Along with that, the Flex-IT act was introduced to congress in order to legislate this change. It’s always hard to predict what congress will do, but many believe that the Flex-IT act will get tagged on to something else and get passed. We’ll see if that indeed happens.

What everyone I talk to agrees is that the 365 day meaningful use stage 2 reporting period is going to be impossible for hospitals to meet. Sure, a few hospitals might make some herculean effort and meet it, but they’ll be so few and far between that they’ll be a rounding error.

What would it mean to healthcare and meaningful use if almost every hospital opts out of the meaningful use program? This isn’t too hard to imagine. A large portion of the meaningful use money has already been spent and the penalties don’t look that bad when you consider the costs and risks associated with the all or nothing meaningful use program.

If the MU reporting period doesn’t change, I think it spells the death of meaningful use. Sure, the program will subsist for those who have attested, but it will be a defunct program with so few participants that the program will have little impact. Plus, we’ll see a wave of efforts to make sure that those penalties for not being meaningful users of an EHR are removed much like has been done with the SGR fix year after year.

The Flex-IT act would at least keep meaningful use on life support. MU 2 is much harder, but with a change to a 90 day reporting period many will do it to avoid the penalties and get the last bit of EHR incentive money. If we want meaningful use to survive, then the Flex-IT act (or something that does something similar) is going to be essential to its future.

I’m just personally not sure that the Flex-IT act is such a great thing for EHR or the industry. Is it better to keep meaningful use on life support or bite the bullet now and have meaningful use die on the vine.

One might argue that meaningful use has accomplished it’s main goal: adoption of EHR software. It’s dramatically accelerated the adoption of EHR software. Would it be such a bad thing for meaningful use to disappear now? With MU gone, we could return to a more rationale EHR market. I guess this is where I’m torn on whether getting the Flex-IT act passed is a good or a bad idea.

What do you think? Is the Flex-IT act a good idea or should we just fall on the sword now as opposed to prolonging the regulation?

Where Do We See the Latest Startup Methodology in Healthcare IT?

Posted on September 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I’ve been spending the day at the Intelligent Insite Build conference in beautiful Fargo, ND. I’ll be on stage later to talk about what’s happening with Healthcare IT. However, the past day at the conference I’ve been really intrigued by the company culture that exists at Intelligent Insites.

While I do almost all of my work in Healthcare IT, I also have a foot in the vegas tech startup world as well. As part of that and my love of tech, I’m always interested in startup culture and the latest trends in startup company creation. What I didn’t expect was to find these startup culture concepts in full bloom in Fargo, ND. I guess I should have known that the Internet and social media were spreading these ideas everywhere. Even in Fargo and even in Healthcare.

Just to share a few examples. It was great to see the whole Intelligent InSites team training on lean startup methodology. The extreme customer service focus is another example. I also loved the way the company has integrated itself into the local startup company ecosystem. I’m sure this is just touching the surface, but is a clear sign of the startup culture they’ve created.

What’s a little surprising to me is that I don’t know of other hospital IT companies that exhibit a similar culture. I’d love to hear if you know of others.

My guess is that we don’t hear about them more in hospital IT because hospitals have a general fear of the “startup” idea. The hospital culture is a no risk culture and the startup culture is seen as one of risks.

What hospitals don’t understand is that a startup is about some business risk, but not patient risk. The former can be a challenge for some organizations, but that’s a risk with organizations of all sizes. A large organization could just as easily cut that department. Plus, a well capitalized startup company is just as stable or more stable than a large company. The patient risk shouldn’t be a concern with a well run startup company.

We need to embrace more of the creativity that startups can bring to an industry. Healthcare can use a bit more creativity.

Are EHR Complex Because Now We Can Make Them Complex?

Posted on September 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I recently had a chance to do some late night research for this blog at a QuickCare center near my house (4 sutures later and I should be fine).  While I was there I dropped the fact that I was an EHR blogger so I could get them to talk about their experiences with EHR. As expected, they had strong feelings about EHR and we’re happy to share. In fact, the next week they were switching EHR software in a big bang style switchover with 4 hours of training before the switch. God bless them on their conversion.

Although, one of the comments that struck me most was from the nurse who said, “I use to use MEDITECH and it was so simple to use.”  They then went on to talk about the old DOS-like user interface that MEDITECH employed and how easy it was to use.

I’ve been thinking a lot about this response and it made me wonder, Are we making EHR more complex because now we can?  Think about it for a second. In the DOS based world, you couldn’t make an application complex because the interface couldn’t support it.

I’m not suggesting we go back to a DOS based interface. However, maybe there’s some lessons to be learned from that simpler time.

For example, could a number of keyboard commands be integrated into the EHR to make it more effecient. You might remember that the DOS-based environment was all keyboard based which was part of its efficiency. It made for a bit more learning curve, but once you mastered it, it was incredibly fast.

One thing that is missing from EHR today is simplicity. Maybe looking back might help us remember a simpler day.

Epic Wants to Be Known for Interoperability – Are They Interoperable?

Posted on September 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Epic has been fighting the stigma of being a closed system for a while now. It seems that Epic isn’t happy about this characterization and they’re coming out guns blazing to try and show how Epic is interoperable. They’re so interested in changing this perception that Epic recently hired a lobbyist to change how they’re viewed by the people in DC.

A recent tweet highlighted a slide from the Epic user conference (Epic UGM) that shows how many Epic patient records they’re exchanging per month. Here’s the tweet and graph below:

Farzad Mostashari asks a very good question, “Does that graph help?” I find Farzad’s tweet also interesting because just over a year ago Farzad tweeted another Epic interoperability chart when he was still National Coordinator at ONC. I’ll embed the previous chart below so you can easily compare the two graphs side by side:
Epic Data Sharing Chart

I think Farzad is right to be skeptical about Epic’s claims to interoperability. First, it seems Epic is finally making some progress with Epic to Epic interoperability, but Epic to Non-Epic systems is still far behind. Second, Epic loves to claim how they have charts for some huge percentage of the US population (currently about 314 million people). I bet if we looked at the percentage of total Epic charts that have been exchanged, it would be an extremely small number. I also wonder if the charts above count a full patient chart or something simple like a lab result or prescription.

I don’t want to harp on this too much, because this is a step forward for Epic. Even if they’re not as interoperable as they could be and as we’d like them to be, I’m excited that they’re now at least open to the idea of interoperability.

With that said, I wish that Epic would spend more time and effort on actually being interoperable and not just trying to say that they’re interoperable. This includes committing the resources required to support connections outside of Epic. I’ve heard over and over from health IT vendor after health IT vendor about how hard it is to get Epic to work with them in any form or fashion. There’s a way that Epic could scale their effort to hundreds of other health IT vendors, but they haven’t made the commitment to do so.

Think about the opportunity that Epic has available to them. They have enough scale, reach and clout that they could by force of size establish a standard for interoperability. Many health IT vendors would bend over backwards to meet whatever standard Epic chose. That’s a powerful position to be in if they would just embrace it. I imagine the reason they haven’t done so yet is because the market’s never demanded it. Sometimes companies like Epic need to embrace something even if it doesn’t drive short term sales. I think this is one of those choices Epic should make.

I’m sure that lobbyists can be an effective solution to change perceptions in Washington. However, a far more effective strategy would be to actually fully embrace interoperability at every level. If they did so, you can be sure that every news outlet would be more than excited to write about the change.

Epic Hires DC Lobbying Firm To Fight Closed-System Reputation

Posted on September 15, 2014 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.

For quite some time, everybody’s favorite EMR giant has a “no marketing, no government relations” policy. (In fact, Epic staffers really seem to hate journalists, but maybe they just don’t like me — who knows?)

Anyway, a few weeks ago, reports the ever-watchful HISTalk, it came out that Epic has broken its rule, hiring on DC lobbying firm Card & Associates. While you might think Epic would hire a billion-dollar behemoth, Card is a smallish firm with seven modest accounts and only one healthcare client. It must help, however, that Card is run by the brother of the former White House Chief of Staff under Pres. George W. Bush.

So what made Epic change its standard operating procedure and begin lobbying The Hill? In its federal lobbying disclosure, the EMR firm says that it’s begun lobbying to “educate members of Congress on the interoperability of Epic’s healthcare information technology.”

The timing of the outreach effort isn’t a coincidence, Modern Healthcare astutely notes. As you read this, a team made up of Epic, IBM and a handful of other technology giants are fighting other equally ferocious IT firms to win the roughly $11 billion contract to update the Department of Defense’s clinical systems.

While none of its contract competitors have a strong reputation for interoperability, Epic is seen as much worse, with a RAND Corp. study released in July calling Epic’s systems “closed records.” That had to hurt.

Unless Epic plans to hold health IT classes for Congress over the next several years, I doubt they’ll be able to make their point with largely Luddite Senators and Representatives in Washington on a technical basis. That is, Epic’s lobbyists won’t be able to convince legislators that Epic is interoperable on the merits.

But lobbyists may very well be able to break the ice on The Hill, and sell the idea that those mean, bad old health IT competitors haven’t been telling the truth about Epic. The pitch can include the somewhat matronly CEO, Judith Faulkner, who doesn’t look like the most powerful woman in healthcare or a competitor that would gladly bite your head off and spit it down your neck. Then they can roll out Epic’s pitch that its systems actually are interoperable (between other Epic installs at least). If it sticks even a little bit, whatever the $1.7 billion company spent will have been worth it.

Frankly, I find the idea of portraying Epic as an underdog in any way as downright laughable, and I bet you do too. But I simply can’t imagine another pitch that would work.

Hospitals and Wearables

Posted on September 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I’ve been pretty closely following the various wearable options that have been entering the tech marketplace as part of my mobile health coverage. The most recent coverage is of the Apple Watch that was just announced. It’s a fascinating market and one that’s just barely getting started. It includes everything from smartwatches to eyeware (led by Google Glass) to contact lenses to fitness trackers to even your smartphone and more.

As I think about the wearable marketplace, I was thinking about how these wearables will apply in the hospital setting. I’d divide wearables impact on hospitals into two main categories: enterprise wearables and consumer (patient) wearables.

Enterprise Wearables
In the enterprise wearables space, I think we’ve seen the most traction with Google Glass. There are a whole plethora of eyeware computing companies that are using Google Glass in enterprise applications in hospitals. I’d say that most of the solutions revolve around telemedicine like applications, but we also see a few that are starting to integrate with other outside data and displaying that to the doctor. We’ve also seen a few applications where Google Glass has been used to document something for the patient. I’m interested to see how these technologies evolve over time. The tests of all of these things are so early that it’s hard to say if they are must have features for every hospital organization.

I have yet to see an enterprise smartwatch implementation. I expect that the first implementation will likely be in the healthcare communication space. One challenge in hospitals is definitely around hospital communication. Access to various messages on your watch could make accessing them easier. I’m not so bullish on this idea because it’s not that much easier than just pulling out your smart phone.

In the enterprise wearables world, what does seem clear to me is that these applications will have to integrate with the legacy systems. There are a few implementations (ie. Telemedicine applications) where this isn’t completely necessary, but the applications will have limited benefit to a hospital without a great integration with the other hospital systems.

Patient Wearables
I’m much more bullish on the various patient wearables. Many of these wearables were designed for consumers, so it makes sense that they would work well for consumers. Take for example, a smart watch. What a perfect way to track a diabetic and remind them of appropriate treatment. I’ve seen this done with smartphones and that’s pretty smooth, but a watch is even easier. Done right, it can be made so easy, even my mother could do it (no offense to my mother, but she’s not very technical). I love that type of monitoring and tracking that could be done with patients and hopefully reduce hospital readmissions and ensure care plans are followed. I haven’t seen anyone doing it yet, so maybe that’s an opportunity waiting for you.

I’m less excited about eyeware computing with patients. There might be some edge cases, but I haven’t seen or heard of any great patient focused applications with Google Glass. If you know of some, I’d love to hear of any.

Those are a few of my thoughts on wearables in the hospital. I’m sure there are plenty of implementations and technologies I’m missing. It’s a rapidly changing area. I’d love to hear your thoughts on what’s happening with wearables in hospitals or things you think could or should happen with them.

The Various Approaches to Mobility in Healthcare

Posted on September 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I’m about to head down to the CTIA Super Mobility Week conference. I try to attend a few conferences each year that aren’t directly related to healthcare and health IT in order to get a broader perspective on what’s happening in the rest of the world. I think this will be one such case (although, they do have some mHealth sessions and exhibitors as well).

As I started to think about mobility and where it’s headed, the industry is all about the smart phone and smart mobile devices. I think it’s an incredibly powerful concept and one that will only become more important. However, I think that many people are taking it too far. While I love my smartphone and its capabilities, I still love the productivity that’s possible with a great desktop setup with dual monitors, a mouse and a keyboard. I’m not sure we’ll replicate that in a mobile world and I’m not sure we should.

In fact, it’s one of the trends I hate most about many of the website designs that are coming out lately. They are going all in on mobile and in the process they’re killing the productivity of the desktop experience. It’s a travesty and continues to annoy me with many of the applications I use on a daily basis.

We can apply this same principle to healthcare IT. Often we need to step back and ask ourselves if something really needs to be mobile or not. Plus, if we decide to make something mobile, we need to ensure that those who still use the same application in a non-mobile environment have their workflow optimized as well.

At the end of the day, we need to create a much more sophisticated approach to mobile computing. There are many times when a doctor or nurse really need whatever they’re working on to be mobile. There are extreme benefits to having a point of care device which allows the nurse or doctor to document at the point of care. However, there are just as many times when mobility is actually a hindrance to the required workflow.

What are you doing in your organization to leverage the amazing mobile technologies that are out there while still maintaining the optimized workflow?