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Study: Scribes Have Positive Financial Impact

Posted on May 22, 2015 I Written By

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

Many hospitals, and some larger medical practices, have been using scribes to capture medical documentation within EMRs — leaving the provider free to make old-fashioned eye contact with patients.

Using the scribe might sound like a crude workaround to techies, but it’s been a hit with emergency department doctors, who prefer to focus on their brief, critical encounters with patients rather than the hospital’s expensive toy.

While it was clear from the outset that doctors loved having a scribe to support them, there’s been scant evidence that the scribe was anything other than an added cost.

A recent study, however, has concluded that at least from a Case Mix Index standpoint, scribes can have a meaningful impact on a hospital’s revenue.  The study, which evaluated the use of scribes between 2012 and 2014 across a group of hospitals, concluded that the scribes save money and boost patient-doctor communication.

The study, which was designed to capture the impact of medical scribes on a hospital’s CMI, linked Best Practices Inpatient Care Ltd. with Advocate Good Shepherd Hospital, Advocate Condell Medical Center and hospitalist-specific medical scribes from ScribeAmerica LLC.

Kicking things off to a good start, ScribeAmerica and Best Practices put scribes through a jointly-developed course that emphasized workflow, productivity and accurate inpatient documentation. The researchers then tallied the results of using trained scribes over a two-year period in the two hospitals.

From 2012 to 2014, researchers found that for both Advocate Condell Medical Center and Advocate Good Shepherd Hospital, CMI values climbed after medical scribes came on board.  Advocate Good Shepherd’s CMI grew by .26 and Condell Medical’s CMI rose .28. These are pretty significant numbers given that a CMI growth of 0.1% typically translates to a gain of about $4,500 per patient. In this case, the hospitals gained roughly $12,000 per patient.

These findings make sense when you consider that using scribes seems to have served its purpose, which is to be extenders for providers who’d otherwise be hunched over an EMR screen.

Researchers found that inpatient physicians at the two hospitals studied were able to cut time spent on chart updates by about 10 minutes per patient on average. This profit-building effect is enhanced by the fact that scribes often get discharge summaries prepared immediately, rather than within 72 hours as is often the case in other hospitals.

That being said, it should be noted that the study we’ve summarized here was co-written by the CEO of Best Practices, which clearly invested a lot of time and effort training the scribes for the specific tasks important to the study.

Still, the study does suggest, at minimum, that scribes need not necessarily be written off as an expense, given their capacity for freeing providers for billable clinical activity. Ideally, IT vendors will develop an EMR that doctors actually want to use and don’t need an intermediary to work with effectively.  But until that happy day arrives, scribes seem like they can make a difference.

Medical Device Vendors Will Inevitably Build Wearables

Posted on May 21, 2015 I Written By

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

As we’ve reported in the past, hospitals are throwing their weight behind the use of wearables at a growing clip. Perhaps the most recent major deal connecting hospital EMRs with wearables data came late last month, when Cedars-Sinai Medical Center announced that it would be running Apple’s HealthKit platform. Cedars-Sinai, one of many leading hospitals piloting this technology, is building an architecture that will ultimately tie 80,000 patients to its Epic system via HealthKit.

But it’s not just software vendors that are jumping into the wearables data market with both feet. No, as important as the marriage of Epic and HealthKit will be to the future of wearables data, the increasing participation of medical device giants in this market is perhaps even more so.

Sure, when fitness bands and health tracking smartphone apps first came onto the market, they were created by smaller firms with a vision, such as the inventors who scored so impressively when they crowdfunded the Pebble smartwatch.  (As is now legendary, Pebble scooped up more than $20M in Kickstarter funding despite shooting for only $500,000.)

The time is coming rapidly, however, when hospitals and doctors will want medical-grade data from monitoring devices. Fairly or not, I’ve heard many a clinician dismiss the current generation of wearables — smartwatches, health apps and fitness monitoring bands alike — as little more than toys.  In other words, while many hospitals are willing to pilot-test HealthKit and other tools that gather wearables data, eventually that data will have to be gathered by sophisticated tools to meet the clinical demands over the long-term.

Thus, it’s no surprise that medical device manufacturing giants like Philips are positioning themselves to leapfrog over existing wearables makers. Why else would Jeroen Tas, CEO of Philips’ healthcare informatics solutions, make a big point of citing the healthcare benefits of wearables over time?

In a recent interview, Tas told the Times of India that the use of wearables combined with cloud-based monitoring approaches are cutting hospital admissions and care costs sharply. In one case, Tas noted, digital monitoring of heart failure patients by six Dutch hospitals over a four-year period led to a 57% cut in the number of nursing days, 52% decrease in hospital admissions and an average 26% savings in cost of care per patient.

In an effort to foster similar results for other hospitals, Philips is building an open digital platform capable of linking to a wide range of wearables, feeds doctors information on their patients, connects patients, relatives and doctors and enables high-end analytics.  That puts it in competition, to one degree or another, with Microsoft, Qualcomm, Samsung, Google and Apple, just for starters.

But that’s not the fun part.  When things will get really interesting  is when Philips, and fellow giants GE Healthcare and Siemens, start creating devices that doctors and hospitals will see as delivering medical grade data, offering secure data transmission and integrating intelligently with data produced by other hospital medical devices.

While it’s hard to imagine Apple moving in that direction, Siemens must do so, and it will, without a doubt. I look forward to the transformation of the whole wearables “thing” from some high-end experimentation to a firmly-welded approach built by medical device leaders. When Siemens and its colleagues admit that they have to own this market, everything about digital health and remote monitoring will change.

The Hospital With No EMR

Posted on May 20, 2015 I Written By

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

This weekend, feeling a bit too ill to wait to see my PCP, I took myself to a community hospital in my neighborhood. For various reasons, I went to a hospital I don’t usually visit, one about 10 miles away from my home.

When I entered the emergency department lobby, nothing seemed amiss.

In fact, the light-filled, pleasantly-constructed waiting room was comfortable and modern, the staff seemed bright and knowledegeable, and the triage nurse saw me promptly.

But I got something of a surprise when I checked in with the triage nurse during my initial assessment. Noting that she had not taken my medication history, I told the nurse that I assumed someone would be entering it into their EMR later.

“We don’t have an EMR,” said the kind and sympathetic triage nurse apologetically. “Everything is still on paper. We might have an EMR in a year or so, but we’re not even sure about that.”

As it later turned out, she was mistaken. The hospital did indeed have an EMR in place, one by MEDITECH, but had put all new upgrades on hold, leaving the clinical staff to do almost all documentation on paper.  Regardless, the staff didn’t have access to the higher capabilities of an EMR, and that’s the message that the triage nurse had gotten. (And no one ever did take my list of medications.)

Now, it’s not necessarily the case that this hospital had no grasp of its data. In fact, to my surprise, the front desk was able to tell me that I had been seen there in 2002, something of which I had no memory.

But it’s hard to imagine that the very long wait I endured, which took place in the attractive lobby of a quiet, prosperous suburban hospital, was not due in part to the hospital’s lack of automation. It should be noted that within the next several months to a year, the chain to which the hospital belonged expects to bring the hospital I visited onto its Epic platform. But again, the staff was stumbling around in the dark, comparatively speaking, the day I visited the ED.

Now, hospitals survived on paper documentation for many years, and there’s no reason to think this one won’t survive for a year or so using paper charts. What’s more, it may very well be that the real problem this hospital faced had to do with patient mix and staffing concerns. I did note that many of the patients coming in seemed to be seeking weekend primary care, for which the hospital may not have been as prepared as it should have been.

That being said, an EMR is not just a clinical tool. Put coldly, it’s an instrument of industrial automation which can keep patients moving through the assessment and discharge process more quickly and effectively.

I’m not saying the facility needs to have a fully-launched marquee EMR just to impress patients like myself. In fact, postponing expanding the Epic EMR for a while may be a great financial decision, and from an IT standpoint, better to roll the Epic system out at a sustainable pace than throw it at an unprepared workforce.

But watching nurses and doctors record details on endless sheets of paper, and struggle to track down paper charts for acutely ill patients, was a harsh reminder of what the industry has left behind.

What If Doctors Owned Part of Hospital EMRs?

Posted on May 19, 2015 I Written By

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

After this many years of widespread use, you’d think that physicians would have accepted that EMRs are an inevitable part of practicing medicine — and at least sometimes, a useful tool that helps doctors manage their panel of patients more effectively.  But it seems some hospital administrators have concluded that a significant percentage of doctors loathe EMRs.

I draw this conclusion not from casual conversation with physicians, but from a hospital recruiting advertisement quoted in The New York Times.  The advertisement, which was attempting to attract doctors to a facility in Phoenix, closed its glowing description of state-of-the-art equipment and an attractive location with a single provocative line, all in bold: “No E.M.R.s.”

While EMRs are getting long in the tooth these days, they haven’t won over many doctors. As physician Robert Wachter notes in his NYT piece on the subject, a 2013 RAND survey found physicians most unhappy with EMRs, citing “poor usability, time-consuming data entry, needless alerts and poor work flows.”

I think it’s pretty obvious why EMRs continue to stay user-hostile. While doctors are the end users of  EMRs, hospital IT leaders and other CXOs make the final buying decisions. And he (or she) who writes the check makes the rules.

In theory, it’s strongly in hospital management’s interests to force EMR vendors to clean up their usability act.  After all, not only do hospital leaders want their EMRs used effectively, they want the data to be robust enough to be usable for value-based care delivery. But the truth is that hospital leaders are nowhere near demanding enough of EMR vendors. And because they’re the ones writing the checks, doctors get stuck with the ugly results.

But what if there was a way to involve both doctors and hospitals financially, as partners, in buying EMRs?  Not being the world’s greatest finance wizard, I don’t know how a hospital and a group of physicians could structure a deal that would allow them to jointly own the hospital’s EMR system. And I’m aware, though I don’t know how they would be addressed, that there could be significant legal issues to be resolved if the hospital was a not-for-profit entity.

But at least in theory, if doctors were paying for a percentage of the EMR, they’d have a lot more say as to what level of usability they’d demand, what features were most important to them, and what price they’d be willing to pay for the system. In other words, if doctors had skin in the game, it would put a great deal of pressure on vendors to make EMRs doctors actually liked.

Now, I realize that doctors might have no interest in buying into a technology which has let them down again and again. But there’s a chance that more visionary and tech-friendly physicians might grab the chance to have a substantial say in the EMR-buying process. The idea is worth a look.

EMRs Continue To Raise Malpractice Litigation Risks For Hospitals

Posted on May 18, 2015 I Written By

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

EMRs may yet realize the massive value proposition their fans imagine, but before they get there hospitals still have to roll down a bumpy road.  One threat that continues to loom over hospital EMRs — even if CIOs succeed at battling their high cost and complexity — is the distinct possibility that they will generate new categories of malpractice risk.

With EMRs being increasingly targeted in medical malpractice suits, hospitals and doctors need to be prepared for attacks of this kind. According to a data review by physician-owned med mal insurer the Doctors Company, EMRs were a part of med mal litigation in just 1% of a sample of suits closed between 2007 and 2013, but the frequency doubled between 2013 and 2014 alone, according to a report in Politico. That still only adds up to 2% of cases, but experts expect the number of EMR-involved medical malpractice suits to climb rapidly.

What’s more, trying to bury the mistakes by altering medical records can be a serious mistake. For example, notes an article in Medscape, the documentation which serves as a shield against malpractice accusations can also reveal details of when suspicious changes have been made. While clinicians may not always remember this, EMRs make changes in records after care has been given very easy to trace, something which can end up as quite damning if a patient care outcome is poor.

One particularly common trouble spot for EMR-related errors is self-populating templates, which, while they make life easier for doctors by capturing a patient’s recent medical history, can also create grounds for serious misunderstandings or medical errors.  For example, at a conference attended by Medscape editors, one speaker told the story of a template which generated text saying the patient had had hip surgery — but the patient had actually had a spinal procedure.

Other mistakes EMRs can cause include faulty voice recognition, misinterpretation of drop-down menus, reliance on outdated or error-ridden records and typos that generate medical errors.

However, organizations that are prepared can avoid many of these errors. In an effort to do so, some hospitals and health systems are studying how technologies like EMRs will fit into their workflow. These facilities and systems are creating human-factor teams that conduct simulations in hopes of catching error-causing issues with EMR use before such errors become an issue.  While such teams are not common — though they should be! — a report in iHealthBeat notes that the Society for Simulation in Healthcare had identified at least 165 simulation centers in the U.S. as of summer 2014.

Studying what impact a complex health IT system like an EMR will have on a healthcare staffers seems like a sensible and even brain-dead obvious move. But if less than 200 of the 5,000-odd hospitals are doing so, the healthcare industry has a lot of work to do before it can truly say EMRs are safe.

8 Things the Hospital Website of the Future Will Include

Posted on May 15, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Wall Street Journal has an article that talks about what the hospital website of the future will look like. In the article, the writer offers these 8 suggestions for what a hospital website will include in the next 10 years:

  1. Real-time patient reviews and observations
  2. Quality ratings
  3. Your protected medical record
  4. Literally see a clinician, right now
  5. Advanced help with medications
  6. Prices
  7. Consumer specials
  8. Food ratings

The only one I’d really argue with is the quality ratings item. I think that measuring quality is a really challenging thing and I’m not sure anyone will do it well enough that hospitals will be publishing those ratings on their website.

What’s more important about this list is that almost every one of them could be implemented in a hospital today. There is nothing on the list is not easily achieved technically. A few of them have some financial challenges like “literally see a clinician, right now”, but many in telemedicine are working on that as well.

If I were to describe these changes, I’d suggest that the shift you see described is one of a website that looks to engage the patient versus today’s hospital website which generally tries to not engage the patient. This will be a welcome shift for patients and a major culture shift for hospitals.

Could Vendors Create Interoperability Retroactively If the Government Passed a Mandate?

Posted on May 13, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to Anne Zieger’s post titled “HHS’ $30B Interoperability Mistake“, Richard Schmitz sent out this tweet:

Then, Anne Zieger responded with an intriguing question:

While I don’t think we should peg all the blame on the EHR vendors (many hospitals didn’t want interoperability either), there have been good economic reasons not to be interoperable. Anne’s question is a good one: “Could vendors create interoperability retroactively if the government passed a mandate?”

I think the question is simple: Absolutely.

If EHR vendors had to be interoperable, they would do it. In fact, most EHR vendors have already solved the technical challenges. In some limited areas they’re already sharing data. The problems of healthcare interoperability are not technical, but all financial and political.

I’m hopeful that ACOs and value based reimbursement will push healthcare interoperability to the forefront. However, that will still be a long haul before it’s a reality. What do you think? If there was a mandate would EHRs be able to be interoperable?

Erlanger Health System Takes A Chance On $100M Epic Plunge

Posted on May 11, 2015 I Written By

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

The seemingly eternal struggle between EMR giants Cerner and Epic Systems has ended in another win for Epic, which was the final choice of Chattanooga, TN-based Erlanger Health System. The health system’s CEO, Kevin Spiegel, who said that Cerner had been its other finalist, announced last week that Erlanger would spend about $100 million over 10 years for the Epic installation.

Erlanger, a four-facility public hospital system with about 800 total beds, is an academic medical system and serves as a campus of the University of Tennessee College of Medicine. The system also partners with UT to operate the UT Erlanger Physicians Group, a 170-member multispecialty practice.

The health system, which fell in financial trouble in 2012, only recently saved itself and positioned itself for the massive Epic investment. It closed out FY 2014 with $618M in total operating revenue and $18M in operating income.

Erlanger’s turnaround is all well and good. But that being said, these numbers suggest that Erlanger is making something of a gamble by agreeing to an approximately $10M a year health IT investment. After all, the health system itself concedes that its return to financial health came in large part due to $20 million in new Medicare and Medicaid funding from CMS, along with new funding from the state’s Public Hospital Supplemental Payment Pool. And politically-obtained funds can disappear with the stroke of a pen.

The risky nature of Erlanger’s investment seems even more apparent when you consider that the system has an aggressive building plan in place, including a new orthopedic center, a $68M expansion of one of its hospitals, a 100,00 square foot children’s & women’s ambulatory center and a new health sciences center. Particularly given that Erlanger just completed its turnaround last year, does it make sense to squeeze in Epic payments alongside of such a large capital investment in infrastructure?

What’s more, the health system has a bond rating to rehabilitate. Faced with financial hardships in 2013, its bond rating was downgraded by Moody’s to a Baa2 and the system’s outlook was rated “negative.” By 2014, Erlanger’s had managed to boost the Moody’s outlook to “stable,” in part due to the influx of state and federal funds obtained by Erlanger execs, but the Baa2 rating on its $148.4 million in bond debt stayed in place.

While I imagine the hospital will realize a return on its Epic spending at some point, it’s hard to see it happening quickly.  In fact, I’d guess that it’ll be years before Erlanger’s Epic install will be mature enough to be evaluated for ROI, given the level of effort it takes to build a mature install.

In the meantime, Erlanger leaders may be left wondering, from time to time at least, whether they really can afford their expensive new EMR.

Did Hospitals Put Off RCM Upgrades for Nothing?

Posted on May 8, 2015 I Written By

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

In December of last year, I wrote a piece outlining a study on revenue cycle management systems by research firm Black Book.  The piece noted that despite hospitals’ desperate need to modernize their RCM platforms, such upgrades were being put off over and over again, largely due to the cost of ICD-10 switchover and Meaningful Use compliance.

It’s hard to say whether ICD-10 prep or  MU compliance have been a greater strain on hospital budgets, but it’s clear that ICD-10 preparations have been a major distraction and a major cost.  Even if a hospital’s EMR has included ICD-10 codes in is platforms or upgrades, hospitals have still had to reconfigure some systems, do revenue impact testing with payers, conduct readiness testing with clearinghouses and train with their claims processing staff, and none of it has been cheap. And the longer hospitals wait to pull the trigger, the worse things get. The American Hospital Association recently estimated that delaying the ICD-10 switchover deadline has cost the hospital industry billions of dollars.

Given the cost of the run-up to the new code set — and the fact that most hospitals report being ready to switch over from ICD-9 — the industry has hoped against hope that the deadline wouldn’t be extended again. In fact, a recently-released survey by software firm QauliTest of more than 150 healthcare executives found that 83% said they think ICD-10 will go live as currently anticipated on Oct. 1.

And that’s where politics enters the picture. While hospitals seem raring to go ahead with the transition and skip any further delays to the deadline,  Texas Rep. Ted Poe (R) has a different outcome in mind.  Perhaps pushed by physicians’ lobbying groups, which still oppose the switch as being too burdensome and costly to handle, Poe has introduced a bill which would actually prohibit HHS from adopting ICD-10 as an ICD-9 replacement.

It’s hard to tell whether the bill will even make it out of the House, as it currently has only six co-sponsors, each fellow Republicans to Poe.  But if it did, hospitals would have plenty to gripe about.

As we’ve pointed out here, one of the major sacrifices hospitals have had to make due to outside forces is to postpone RCM system investment, a lapse which has doubtless cost hospitals plenty due to lost money due to claims processing problems. The longer the need to put off RCM switchovers or improvements lasts, the greater the chance that it hospitals will lose too much to afford on claims old systems can’t handle.

Bottom line, I’d argue that another ICD-10 delay or cancellation of the entire transition would be terribly unfair to hospitals.  If CMS needs to help doctors through the process or even help them pay for it, so be it. Hospitals deserve to be freed to focus on their other IT problems, not wait with bated breath for yet another ICD-10 delay.

ICD-10 Poll

Posted on May 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently saw an ICD-10 survey that looked at ambulatory preparedness for ICD-10. That survey highlighted a number of ICD-10 business areas of concern that are worth considering in hospitals as well:

  • Training/Education
  • Payer Tersting
  • Software Upgrade Cost
  • Claims Processing
  • Compliance Timeline/Deadline

If your hospital hasn’t considered these areas of ICD-10 readiness, then you might want to start doing so now.

Of course, I’m interested to know what people think about ICD-10. Will it get delayed again? Will it finally go forward? Let’s hear what you think in the poll below.

My personal feeling is that if I’m running a hospital, I’m going to have to act like ICD-10 is going forward and plan accordingly. I don’t want to be caught unprepared because I was holding out hope that it would be delayed again. What do you think? Is that wise advice for hospitals?