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Study Suggests That Hospitals Do Better With Richer Clinical EHR Tech Support

Posted on November 29, 2017 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.

It’s hardly a mystery that providers get more use out of health IT when they get good support from the vendors who created it. According to one study, however, today’s vendors need to go further with the tech support offerings, including services extending from helpdesk through engineering interventions.

The study, conducted by research firm Black Book, involved interviewing 4,446 nurses and physicians about the quality of clinical tech support services needed to have an impact on patient care. A large majority (85%) of clinicians said that delivery of patient care services is undermined substantially by subpart user tech support, Black Book reports.

Additional interesting data came from the 1,103 respondents who reported having worked in varied facilities using different EHR systems, which gave them perspective on how tech support options impacted clinical care. Of that group, 77% of nurses and 89% of doctors said the hospitals benefited from advanced tech support, which created an excellent EHR end-user experience.

All that being said, hospital financial leaders didn’t seem confident that they could afford to pay for top-tier tech support for health IT tools. According to the survey, 155 of the 180 CFOs and financial executives who responded to the survey felt they faced too many challenges and had too few resources budgeted for 2018 to spend on additional EHR support next year.

On the other hand, the CFOs are going to get pushback from their colleagues in other departments, the survey suggests. According to the study, 49 of 82 CMOs said they were routinely discontented with a range of tech support provided to the nursing and physician employees. Meanwhile, 80% of the 1,319 IT management and CIO respondents reported that they were seeing a steep increase in clinical grievances after EHR implementation, especially among physicians.

And if they have the opportunity, they’re going to demand more from vendors on the tech support front. In fact, 70 of the 82 hospital CMOs surveyed believe that the availability of multi-level tech support from their health records vendors will be a top competitive differentiator distinguishing one inpatient EHR from the others.

So here, we have the makings of some serious financial tensions between hospitals and EHR vendors. On the one hand, CFOs are signaling that they don’t want to pay extra for additional support, even if it has the potential for improving clinical performance. CIOs and CMO’s, for their part, are willing to shortlist vendors that do a better job of supporting key end-users like physician after EHR rollouts.

Will the more aggressive vendors absorb the cost of delivering more comprehensive, clinical-friendly tech support? Or will hospital financial leaders give in to internal pressure and pay for more sophisticated support?  It’s too soon to tell who has more muscle here, but my guess is that given the still-crowded EHR market, the vendors will eventually be forced to give in and offer better tech support options as part of their base price. My guess is that hospitals still hold more of the cards.

Providing ongoing support for an EHR and other healthcare IT has become such a challenge, we’ve made it one of the themes at our new Health IT Expo conference. If finding a sustainable way to support your EHR at every tier, then join us in New Orleans to learn and share with other hospital organizations that are going through the same challenges.

Predictive Analytics Will Save Hospitals, Not IT Investment

Posted on October 27, 2017 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.

Most hospitals run on very slim operating margins. In fact, not-for-profit hospitals’ mean operating margins fell from 3.4% in fiscal year 2015 to 2.7% in fiscal year 2016, according to Moody’s Investors Service.

To turn this around, many seem to be pinning their hopes on better technology, spending between 25% and 35% of their capital budget on IT infrastructure investment. But that strategy might backfire, suggests an article appearing in the Harvard Business Review.

Author Sanjeev Agrawal, who serves as president of healthcare and chief marketing officer at healthcare predictive analytics company LeanTaaS, argues that throwing more money at IT won’t help hospitals become more profitable. “Healthcare providers can’t keep spending their way out of trouble by investing in more and more infrastructure,” he writes. “Instead, they must optimize the use of the assets currently in place.”

Instead, he suggests, hospitals need to go the way of retail, transportation and airlines, industries which also manage complex operations and work on narrow margins. Those industries have improved their performance by improving their data science capabilities.

“[Hospitals] need to create an operational ‘air traffic control’ for their hospitals — a centralized command-and-control capability that is predictive, learns continually, and uses optimization algorithms and artificial intelligence to deliver prescriptive recommendations throughout the system,” Agrawal says.

Agrawal predicts that hospitals will use predictive analytics to refine their key care-delivery processes, including resource utilization, staff schedules, and patient admits and discharges. If they get it right, they’ll meet many of their goals, including better patient throughput, lower costs and more efficient asset utilization.

For example, he notes, hospitals can optimize OR utilization, which brings in 65% of revenue at most hospitals. Rather than relying on current block-scheduling techniques, which have been proven to be inefficient, hospitals can use predictive analytics and mobile apps to give surgeons more control of OR scheduling.

Another area ripe for process improvements is the emergency department. As Agrawal notes, hospitals can avoid bottlenecks by using analytics to define the most efficient order for ED activities. Not only can this improve hospital finances, it can improve patient satisfaction, he says.

Of course, Agrawal works for a predictive analytics vendor, which makes him more than a little bit biased. But on the other hand, I doubt any of us would disagree that adopting predictive analytics strategies is the next frontier for hospitals.

After all, having spent many billions collectively to implement EMRs, hospitals have created enormous data stores, and few would argue that it’s high time to leverage them. For example, if they want to adopt population health management – and it’s a question of when, not if — they’ve got to use these tools to reduce outcome variations and improve quality of cost across populations. Also, while the deep-pocketed hospitals are doing it first, it seems likely that over time, virtually every hospital will use EMR data to streamline operations as well.

The question is, will vendors like LeanTaaS take a leading role in this transition, or will hospital IT leaders know what they want to do?  At this stage, it’s anyone’s guess.

Poll: Providers Struggle To Roll Out Big Data Analytics

Posted on April 10, 2017 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 poll by a health IT publication has concluded that while healthcare organizations would like to roll out big data analytics projects, they lack many of the resources they need to proceed.

The online poll, conducted by HealthITAnalytics.com, found that half of respondents are hoping to recruit data science experts to serve as the backbone of their big analytics efforts. However, many are finding it very difficult to find the right staffers.

What’s more, such hires don’t come cheaply. In fact, one study found that data scientist salaries will range from $116,000 to $163,500 in 2017, a 6.4 percent increase over last year’s levels. (Other research concludes that a data scientist in management leading a team of 10 or more can draw up to $250,000 per year.) And even if the pricetag isn’t an issue, providers are competing for data science talent in a seller’s market, not only against other healthcare providers but also hungry employers in other industries.

Without having the right talent in place, many of providers’ efforts have been stalled, the publication reports. Roughly 31 percent of poll respondents said that without a data science team in place, they didn’t know how to begin implementing data analytics initiatives.

Meanwhile, 57 percent of respondents are still struggling with a range of predictable health IT challenges, including EMR optimization and workflow issues, interoperability issues and siloed data. Not only that, for some getting buy-in is proving difficult, with 34 percent reporting that their clinical end users aren’t convinced that creating analytics tools will pay off.

Interestingly, these results suggest that providers face bigger challenges in implementing health data than last year. In last year’s study by HealthITAnalytics.com, 47 percent said interoperability was a key challenge. What’s more, just 42 percent were having trouble finding analytics staffers for their team.

But at the same time, it seems like provider executives are throwing their weight behind these initiatives. The survey found that just 17 percent faced problems with getting executive buy-in and budget constraints this year, while more than half faced these issues in last year’s survey.

This squares with research released a few months ago by IT staffing firm TEKSystems, which found that 63 percent of respondents expected to see their 2017 budgets increase this year, a big change from the 41 percent who expected to see bigger budgets last year.

Meanwhile, despite their concerns, providers are coping well with at least some health IT challenges, the survey noted. In particular, almost 90 percent of respondents reported that they are live on an EMR and 65 percent are using a business intelligence or analytics solution.

And they’re also looking at the future. Three-quarters said they were already using or expect to enhance clinical decision making, along with more than 50 percent also focusing laboratory data, data gathered from partners and socioeconomic or community data. Also, using pharmacy data, patient safety data and post-acute care records were on the horizon for about 20 percent of respondents. In addition, 62 percent said that they were interested in patient-generated health data.

Taken together, this data suggests that as providers have shifted their focus to big data analytics– and supporting population health efforts – they’ve hit more speed bumps than expected. That being said, over the next few years, I predict that the supply of data scientists and demand for their talents should fall into alignment. For providers’ sake, we’d better hope so!

EMR Add-Ons On The Way

Posted on March 3, 2017 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 backed by speech recognition software vendor Nuance Communications has concluded that many healthcare leaders are planning to add new technologies to supplement their EMRs, Popular add-ons cited by the study include (naturally) speech recognition, mobility options and computer-assisted physician documentation tools. While the results are partially a pitch for Nuance, of course, they also highlight the tension between spending on clinical improvement and satisfaction and boosting the bottom line with better documentation tech.

The study, which was conducted by HIMSS Analytics, was designed to look at ways to optimize EMRs and opportunities to improve care at hospitals and health systems. Conducted between August 17 and September 6 of last year, it draws on 167 respondents from 142 different healthcare organizations. Forty percent of respondents hold C-suite titles, and an additional 40% were in IT leadership. (It would be interesting to see how the two groups’ perceptions vary, but the study summary doesn’t provide that information.)

According to HIMSS, 83% of respondents reported having confidence that their organization would eventually realize their full potential, particularly improving care coordination and outcomes.

To this end, 75% of respondents said they’d boosted their EMR efforts with training and support resources, while two-thirds have increased staff in at least one IT area since implementing their system. Respondents apparently didn’t say how much they’d increased their budget, if at all, to meet these needs – and you have to wonder how these organizations are paying for these efforts, and how much. But the report didn’t provide such information.

To increase clinician satisfaction with EMR use, 82% of respondents said providing clinician training and education, 75% are enhancing existing technology and tools and 68% adopting new technology and tools. To read between the lines once again, it’s worth noting that hospitals and health systems seem to be putting a stronger emphasis on training than new tech, which somewhat contradicts the study’s conclusions. Still, EMR add-ons clearly matter.

Meanwhile, about one-quarter of survey respondents said that they planned to introduce EMR-enhancing tools at the point of care, primarily to improve documentation and boost physician satisfaction. Those included mobility tools (44%), computer-assisted physician documentation (38%) and speech recognition (25%). These numbers seem a bit lower than I would have expected, particularly the mobile stat. I’m betting that establishing mobile security is still a tough nut to crack for most.

While increasing clinician satisfaction and improving care outcomes is important, boosting financial performance clearly matters too, and respondents said that improving documentation was central to doing so. Fifty-four percent said that better documentation would reduce the number of denied claims they face, 52% expect to improve performance under bundled payments, 38% predicted reduced readmissions and 38% thought documentation improvements would better physician time management and improve patient flow.

Again, I doubt that C-suite execs and IT leaders will pay equal attention to tools which improve their finances and those which meet “softer” goals – and financial goals have to take priority. But these stats do suggest that hospitals and health systems are giving EMR add-ons some attention. It will be interesting to see if they’re willing to invest in EMR enhancements — rather than burrowing deeper into their existing EMR tech — over the next year or two.

Some Projections For 2017 Hospital IT Spending

Posted on January 4, 2017 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 couple of months ago, HIMSS released some statistics from its survey on US hospitals’ plans for IT investment over the next 12 months. The results contain a couple of data points that I found particularly interesting:

  • While I had expected the most common type of planned spending to be focused on population health or related solutions, HIMSS found that pharmacy was the most active category. In fact, 51% of hospitals were planning to invest in one pharmacy technology, largely to improve tracking of medication dispensing in additional patient care environments. Researchers also found that 6% of hospitals were planning to add carousels or packagers in their pharmacies.
  • Eight percent hospitals said that they plan to invest in EMR components, which I hadn’t anticipated (though it makes sense in retrospect). HIMSS reported that 14% of hospitals at Stage 1-4 of its Electronic Medical Record Adoption Model are investing in pharmacy tech for closed loop med administration, and 17% in auto ID tech. Four percent of Stage 6 hospitals plan to support or expand information exchange capabilities. Meanwhile, 60% of Stage 7 hospitals are investing in hardware infrastructure “for the post-EMR world.”

Other data from the HIMSS report included news of new analytics and telecom plans:

  • Researchers say that recent mergers and acquisitions are triggering new investments around telephony. They found that 12% of hospitals with inpatient revenues between $25 million and $125 million – and 6% of hospitals with more than $500 million in inpatient revenues — are investing in VOIP and telemedicine. FWIW, I’m not sure how mergers and acquisitions would trigger telemedicine rollouts, as they’re already well underway at many hospitals — maybe these deals foster new thinking and innovation?
  • As readers know, hospitals are increasingly spending on analytics solutions to improve care and make use of big data. However (and this surprised me) only 8% of hospitals reported plans to buy at least one analytics technology. My guess is that this number is small because a) hospitals may not have collected their big data assets in easily-analyzed form yet and b) that they’re still hoping to make better use of their legacy analytics tools.

Looking at these stats as a whole, I get the sense that the hospitals surveyed are expecting to play catch-up and shore up their infrastructure next year, rather than sink big dollars into future-looking solutions.

Without a doubt, hospital leaders are likely to invest in game-changing technologies soon such as cutting-edge patient engagement and population health platforms to prepare for the shift to value-based health. It’s inevitable.

But in the meantime it probably makes sense for them to focus on internal cost drivers like pharmacy departments, whose average annual inpatient drug spending shot up by more than 23% between 2013 and 2015. Without stanching that kind of bleeding, hospitals are unlikely to get as much value as they’d like from big-idea investments in the future.

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.

Will Hospital EMR Prices Ever Fall?

Posted on May 9, 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.

In most industries, prices fall as supply rises. Basic economics, right? Well, if that’s true, will the price of EMRs fall as the industry matures?  A recent discussion on LinkedIn demonstrates – as you might expect – that there’s a lot of room for debate on the topic.

Davíð Þórisson, an emergency physician at Landspitali University Hospital in Iceland, kicked things off with this question:

Now that the major workflow has been designed in all major EHR systems available it would seem the biggest part of the hospital needs are addressed. Competition should increase as more vendors catch on… prices surely must go down from here?

Nelson Wong, a senior consultant with Fuji Xerox, responded that price increases are all but inevitable when EMR vendors compete with proprietary technology:

The only way out is a vendor neutral EHR providers to integrate all systems with international standard like HL7.

Zac Whitewood-Moores, a clinical data standards specialist who’s helping to implement SNOMED CT in systems across the NHS in England, noted that EMR vendors currently have little incentive to switch to a cheaper, less-customized EMR model:

Vendors appear reluctant to share work from previous deployments and part of this has to be that the commercial model is built on consultancy, not just licensing of the IT product itself.

But Whitewood-Moores also holds out hope that true data interoperability could do the trick:

When there is more use of SNOMED CT and common interoperability models forced by purchasing goverments/health providers…this may bring down costs if customers are not locked in by their data and the costs of migrating large amounts of it.

And Ryan Pena, social media manager at MentorMate and MobCon, argued that innovation might yet reduce health data management costs:

I think the key with EHRs is to ensure the industry continues to innovate on how information is captured. Perhaps secure automation will drive down this cost as we learn ways to transfer health data from medical grade wearables?

On the other hand, other people who commented felt that even some kind of open source reference EMR wouldn’t do the trick. John Shepard, president and co-founder of HIT software vendor Shepard Health, points out that there’s actually surprisingly little pressure on vendors to lower prices, in part because the market is still evolving:

The cost of EHRs has already gone down but also up. For example, you can buy an EHR out of the box at Costco or utilize one of the open source EHRs for free. However, to get a supported enterprise-level EHR (Epic, McKesson, etc.) then the price is very high and I don’t think it will come down anytime soon…[After all,] the cost of the EHR is not preventing sales because there is minimal change in demand based on increase in cost.

Meanwhile Pim Volkert, terminologies coordinator for Nicitz, the National IT Institute for Healthcare in the Netherlands, shared an interesting view of the future. He seems to suggest that paying more for EMRs may actually be justified as they grow more sophisticated:

EHRs will move more and more into the clinical domains. [They] will become a medical device just like an MRI or DaVinci robot. Development, testing of software and liability insurance fees will increase costs.

Obviously, there’s no way to predict exactly where EMR prices will go, but I’m more on the side of the posters suggesting that enterprise EMRs have nowhere to go but up. I hope I’m wrong!

Mayo Clinic’s Shift To Epic Eats Up Most of IT Budget

Posted on May 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.

Mayo Clinic has announced that it will spend about $1 billion to complete its migration from Cerner and GE to Epic. While Mayo hasn’t disclosed they’re spending on software, industry watchers are estimating the agreement will cost hundreds of millions of dollars, with the rest of the $1 billion seemingly going to integration and development costs.

The Clinic said in 2014 that it would invest $1.5 billion in IT infrastructure over multiple years, according to the Minneapolis/St. Paul Business Journal. Then last year, it announced that it would replace Cerner and GE systems with an Epic EMR. Now, its execs say that it will spend more than $1 billion on the transition over five years.

Given what other health system spend on Epic installations, the $1 billion estimate sounds sadly realistic. Facing up to these costs is certainly smarter than lowballing its budget. Nobody wants to be in the position New York City-based Health and Hospitals Corp. has gotten into. The municipal system’s original $302 million budget expanded to $764 million just a couple of years into its Epic install, and overall expenses could hit $1.4 billion.

On the other hand, the shift to Epic is eating up two thirds of the Mayo’s $1.5 billion IT allowance for the next few years. And that’s a pretty considerable risk. After all, the Clinic must have spent a great deal on its Cerner and GE contracts. While the prior investments weren’t entirely sunk costs, as existing systems must have collected a fair amount of data and had some impact on patient care, neither product could have come cheaply.

Given that the Epic deal seems poised to suck the IT budget dry, I find myself wondering what Mayo is giving up:

  • Many health systems have put off investing in up-to-date revenue cycle management solutions, largely to focus on Meaningful Use compliance and ICD-10 preparation. Will Mayo be forced to limp along with a substandard solution?
  • Big data analytics and population health tech will be critical to surviving in ACOs and value-based payment schemes. Will the Epic deal block Mayo from investing?
  • Digital health innovation will become a central focus for health systems in the near future. Will Mayo’s focus on the EMR transition rob it of the resources to compete in this realm?

To be fair, Mayo’s Epic investment obviously wasn’t made in a vacuum. With the EMR vendor capturing a huge share of the hospital EMR market, its IT leaders and C-suite execs clearly had many colleagues with whom they could discuss the system’s performance and potential benefits.

But I’m still left wondering whether any single software solution, provided by a single vendor, offers such benefits that it’s worth starving other important projects to adopt it. I guess that’s not just the argument against Epic, but against the massive investment required to buy any enterprise EMR. But given the extreme commitment required to adopt Epic, this becomes a life-and-death decision for the Mayo, which already saw a drop in earnings last year.

Ultimately, there’s no getting past that enterprise EMR buys may be necessary. But if your Epic investment pretty much ties up your cash, let’s hope something better doesn’t come along anytime soon. That will be one serious case of buyer’s regret.

HIMSS Puts Optimistic Spin On EMR Value Data

Posted on February 5, 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.

After several years of EMR deployment, one would think that the EMR value proposition had been pretty well established. But the truth is, the financial and clinical return on EMRs still seems to be in question, at least where some aspects of their functioning are concerned.

That, at least, is what I took from the recent HIMSS “Value of Health IT Survey”  released earlier this month. After all, you don’t see Ford releasing a “Value of Cars Survey,” because the value of a car has been pretty much understood since the first ones rolled off of the assembly line more than a century ago.

Industry-wide, the evidence for the value of EMRs is still mixed. At minimum, the value proposition for EMRs is a remarkably tough case to make considering how many billions have been spent on buying, implementing and maintaining them. It’s little surprise that in a recent survey of CHIME members, 71% of respondents said that their top priority for the next 12 months was to realize more value from their EMR investment. That certainly implies that they’re not happy with their EMR’s value prop as it exists.

So, on to the HIMSS survey. To do the research, HIMSS reached out to 52 executives, drawn exclusively from either HIMSS Analytics EMRAM Stage 6 or 7, or Davies Award winning hospitals. In other words, these respondents represent the creme de la creme of EMR implementors, at least as HIMSS measures such things.

HIMSS researchers measured HIT value perceptions among this elite group by sorting responses into one of five areas: Satisfaction, Treatment/Clinical, Electronic Information/Data, Patient Engagement and Population Management and Savings.

HIMSS’ topline conclusion — its success metric, if you will — is that 88 percent of execs reported at least one positive outcome from their EMR. The biggest area of success was in the Treatment/Clinical area, with quality performance of the clinical staff being cited by 83% of respondents. Another area that scored high was savings, with 81% reporting that they’d seen some benefits, primarily in coding accuracy, days in accounts receivable and transcription costs.

On the other end of the scale, execs had to admit that few of their clinical staffers are satisfied with their EMRs. Only 29% of execs said that their EMR had increased physician satisfaction, and less than half (44%) said their nurses were more satisfied. If that isn’t a red flag I don’t know what is.

Admittedly, there are positive results here, but you have to consider the broader context for this study. We’re talking about a piece of software that cost organizations tens or even hundreds of millions of dollars, upon which many of their current and future plans rest. If I told you that my new car’s engine worked and the wheels turned, but that the brakes were dodgy, fuel economy abysmal and the suspension bumpy, wouldn’t you wonder whether I should have bought it in the first place?

Is An Epic Investment Bad For Health Leaders’ Job Stability?

Posted on January 28, 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.

For quite some time now, the buzz has been that at least one EMR vendor was a safe bet for everyone involved. “No one ever got fired for choosing Epic” has begun to seem as obvious a sentiment as “No one ever got fired for choosing IBM” in hospital C-suites. And certainly, in previous times that was probably true.

But it’s beginning to look as though at least in some cases, Epic has not been as safe a choice as health execs had hoped. In fact, while it’s not exactly a fully-fledged trend, it’s worth noting that Epic-related costs and technical issues have led to job losses for hospital CIOs, as well as other operational leaders, in recent times.

Perhaps the most recent example of Epic-related job attrition took place earlier this month, when the chief information officer and chief operating officer of Denver Health Medical Center. According to the Denver Post, the two executives left their posts in the wake of major disagreements over the medical center’s big investment in an Epic EMR.

The Denver Post story reports that former Denver Health CIO Gregory Veltri was on the outs with CEO Arthur Gonzalez from the outset where Epic was concerned. Apparently, Veltri argued from the get-go that the Epic install costs — which he estimated could hit $300 million when the $70 million cost of dumping the center’s current EMR contract and doubling of its IT staff were computed — stood a chance of bankrupting the hospital. (Gonzalez, for his part, claims that the Epic installation is under budget at $170 million, and says that the system should go live in April.)

In another example of Epic-related turnover, the chief information officer at Maine Medical Center in Portland seems to have left his job at least in part due to the financial impact of the hospital’s $160 million Epic investment. Admittedly, the departure of CIO Barry Blumenfeld may also have been related to technical problems with the rollout which slowed hospital collections. This took place back in 2013, but it still seems noteworthy.

The spring of 2013 also saw the departure of Sheila Sanders, the chief information officer for Wake Forest Baptist Medical Center, in the midst of the medical center’s struggles to implement its own Epic system. While Wake Forest Baptist had spent a comparatively modest $13.3 million on direct Epic costs during its second quarter of fiscal 2012-13, the medical center had been socked by delays in revenue resulting to Epic rollout problems, including issues with billing, coding and collections.

Wake Forest Baptist reported taking an $8 million hit that quarter due to “business-cycle disruptions (that) have had a greater-than-anticipated impact on volumes and productivity.” It also reported $26.6 million in lost margin due to reduced volume during go-live and post go-live Epic optimization.

Of course, a botched rollout can mean job insecurity no matter what EMR the hospital has chosen. For example, in May of 2014, Athens Regional Medical Center President and CEO James Thaw was apparently pressured out of office when the facility’s Cerner rollout went poorly. (After weeks of Cerner problems, the hospital’s staff voted 270-0 that they had “no confidence” in the hospital’s leadership. Gulp!) Somehow, Senior Vice President and CIO Gretchen Tegethoff kept her job, but my bet is that it was a close-run thing.

And to be fair, this is obviously a small, selected set of anecdotes about questionable Epic rollouts. They don’t prove that Epic is a CIO job killer or an ineffective EMR. But these stories do highlight the fact that while Epic investments might yield good things, rolling Epic out requires nerves of steel and flawless execution.