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Telemedicine A Growing Priority For Hospitals

Posted on April 29, 2016 I Written By

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

Telemedicine programs are not new to hospitals. In fact, tele-stroke and tele-ICU programs have gained significant ground over the past several years, and other subspecialties, such as tele-psychiatry, seem likely to grow in popularity.

In coming years, telemedicine will go from being a one-off strategy to an integral part of hospital care delivery, if a new survey is any indication. Government and private insurers are gradually agreeing to pay for telemedicine services, knocking down the biggest obstacle to rolling out such programs. And while integrating telemedicine services with EMRs poses major challenges, hospital leaders seem determined to address them.

Virtually all of the hospitals responding to the survey, which was conducted by telemedicine vendor ReachHealth, told researchers that they were busy planning and preparing for telemedicine programs. Twenty-two percent of survey respondents, which also included some medical practices, said that rolling out telemedicine programs was one of their top priorities, and another 44% said that it was a high priority. Health systems averaged 5.51 telemedicine service lines, up almost 20% from last year.

I was interested to note that 96% of respondents were planning to roll out telemedicine because they felt it would improve patient outcomes. I’m not aware that there’s any substantial body of evidence demonstrating that telemedicine can have this effect, but clearly this is a widespread belief.

Also, it was a bit surprising to read that “improving financial returns” was a very low priority for providers when developing telemedicine programs. On the other hand, as researchers point out, hospitals and practices to see improved patient satisfaction as a driver of ROI. Apparently, execs responding to this survey are convinced that telemedicine to have a substantial effect on satisfaction and outcomes, though to date, only 55% said telemedicine was improving outcomes and 44% felt it was boosting patient satisfaction.

Researchers also found that providers that dedicate more resources to telemedicine are seeing more success than those that don’t. Specifically, hospitals and clinics that have a 100% dedicated telemedicine program manager in place were doing better with their initiatives.

In fact, two thirds of respondents with a dedicated program manager in place ranked their efforts to be “highly successful,” while only 46% of programs without a dedicated program manager met that description. (The programs were most successful when a VP or director was put in charge of telemedicine efforts, but only slightly more than when a CEO or coordinator was in charge.)

That being said, it seems that the highest barriers to telemedicine success are technical. The respondents complained that the lack of common EMR in hub and spoke hospitals, and the lack of integration between telemedicine and their current EMR, were still standing in their way. Many were also concerned about the lack of native telemedicine capabilities in their EMR.

Despite all of the obstacles to creating a flourishing telemedicine program, hospitals and clinics have continued to make progress. In fact, 36% have had a tele-stroke program in place for more than three years, 23% tele-radiology for three years plus, and 22 percent have had neurology and psychiatry telemedicine programs for three years or more. ReachHealth researchers note that service lines requiring access to specialists are growing more rapidly than other service lines, but contend that this is likely to shift given pending shortages of primary care physicians.

Admittedly, any survey published by telemedicine vendor is likely to be biased. Still, I thought these statistics were worth discussing. Do they track with what you’re seeing out there? And do you think EMR vendors will do more to support telemedicine anytime soon?

It’s Time For A New HIE Model

Posted on April 25, 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.

Over the decade or so I’ve been writing about HIEs, critics have predicted their death countless times – and with good reason. Though their supporters have never backed down, it’s increasingly clear that the model has many flaws, some of them quite possibly fatal.

One is the lack of a sustainable business model. Countless publicly-funded HIEs, jumpstarted by state or federal grants, have stumbled badly and closed their doors when the funding dried up. As it turns out, it’s quite difficult to get hospitals to pay for such services. Whether this is due to fears of sharing data with the competition or a simple reluctance to pay for something new, hospitals haven’t moved much on this issue.

Another reason HIEs aren’t likely to stay alive is that none can offer true interoperability, which diminishes the benefits they offer. Admittedly, some groups won’t concede this issue. For example, I was intrigued to see that DirectTrust, a collaborative embracing 145 health IT and provider organizations, is working to provide interoperability via Direct message protocols. But Direct messaging and true bilateral health information exchange are two different things. (I know, I’m a spoilsport.)

Yet another reason why HIEs have continued to struggle is due to variations in state privacy rules, which add another layer of complexity to managing HIEs. Simply complying with HIPAA can be challenging; adding state requirements to the mix can be a big headache. State laws vary as to when providers can disclose PHI, to whom it can be disclosed and for what purpose, and building an HIE that meets these requirements is a big deal.

Still, given that MACRA demands the industry achieve “widespread interoperability” by 2018, we have to have something in place that might work. One model, proposed by Dr. Donald Voltz, is to turn to a middleware solution. This approach, Voltz notes, has worked in industries like banking and retail, which have solved their data interoperability problems (at least to a greater degree than healthcare).

Voltz isn’t proposing that healthcare organizations rely on building middleware that connects directly to their proprietary EMR, but rather, that they build an independent solution. The idea isn’t incredibly popular yet — just 16% of hospital systems reported that they were considering middleware, according to Black Book – but the idea is gaining popularity, Voltz suggests. And given that hospitals face continued challenges in integrating new inputs, like mobile app and medical device data, next-generation middleware may be a good solution.

Other possible HIE alternatives include health record banks and clearinghouses. These have the advantage of being centralized, connected to yet independent of providers and relatively flexible. There are some substantial obstacles to substituting either for an HIE, such as getting consumers to consistently upload their records to the record banks. Still, it’s likely that neither would be as costly nor as resource-intensive as building EMR-specific interoperability.

That being said, none of these approaches are a pushbutton solution to data exchange problems. To foster health data sharing will take significant time and effort, and the transition to implementing any of these models won’t be easy. But if the existing HIE model is collapsing (and I contend this is the case) hospitals will need to do something. If you think the models I’ve listed don’t work, what do you suggest?

NYC Epic Rollout Faces Patient Safety Questions

Posted on March 30, 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 the summer of last year, we laid out for you the story of how a municipal hospital system’s Epic EMR installation had gone dramatically south since its inception. We told you how the New York City-based Health and Hospitals Corp. was struggling to cope with problems arising from its attempt to implement Epic at its 11 hospitals, four long-term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.

At the time of last writing, the project budget had exploded upward from $302 million to $764 million, and the public chain’s CTO, CIO, CIO interim deputy and project head of training had been given the axe. In the unlikely event that you thought things would settle down at that point, we bring you news of further strife and bloodshed.

Apparently, a senior clinical information officer with the chain’s Elmhurst and Queens Hospital Centers has now made allegations that the way the Epic install was proceeding might pose danger to patients. A New York Post article reports that in a letter to colleagues, outgoing HHC official Charles Perry, M.D. compared the EMR implementation process to the 1986 Challenger space shuttle disaster.

In his letter, Dr. Perry apparently argued that the project must be delayed. According to the Post, he quoted from a presidential panel report on the disaster: “[For] a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Another Post article cited anonymous “insider” sources claiming that the system will crash, as the implementation is being rushed, and that the situation could lead to patient harm.

For its part, HHC has minimized the issue. A spokesperson told FierceHealthIT that Perry was associate executive director of the Elmhurst hospital and liason to the Queens Epic project, rather than being CMIO as identified by the Post. (Further intrigue?) Also, the spokesperson told FHIT that “if a patient safety issue is identified, the project will stop until it is addressed.”

Of course, the only people who truly know what’s happening with the HHC Epic implementation are not willing to go public with their allegations, so I’d argue that were obligated to take Perry’s statements with at least a grain of salt. In fact, I’d suggest that most large commercial Epic installations (and other large EHR implementations for that matter) got the scrutiny this public hospital system gets, they’d probably look pretty bad too.

On the other hand, it’s fair to say that HHC seems to crammed enough scandal into the first few years of its Epic rollout for the entire 15-year project. For the sake of the millions of people HHC serves, let’s hope that either there is not much to these critiques — or that HHC slows down enough to do the project justice.

Hospital EMR Buyer Loyalty May Be Shaky

Posted on February 22, 2016 I Written By

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

When it comes to investing in enterprise software, just about any deal can turn sour. If you’re acquiring a mission-critical platform, there’s an even bigger risk involved, and the consequences of failure are typically dire. So any company making such a purchase may feel trapped after the contract is signed and the die has been cast.

One might hope that when hospital and health systems buy an EMR — probably the most expensive and critical software buy they’ll make in a decade — that they feel comfortable with their vendor. Ideally, hospitals should be prepared to switch vendors if they feel the need.

In reality, however, it looks like many hospitals and health systems feel they’re trapped in their relationship with their EMR vendor. A new study by research firm Black Book has concluded that about a solid subset of hospitals feel trapped in their relationship with their EMR vendor. (Given what I hear at professional gatherings, I’m betting that’s on the low side, as their EMR has driven so many hospitals deep into debt.)

Anyway, Black Book compiles an HIT Loyalty Index which assesses the stability of vendors’ customer base and measures those customers’ loyalty. For its current batch of stats, Black Book drew on 2,077 hospital users, asking about their intentions to renew current contracts, recommend their inpatient EMR/HIT vendor to peers and the likelihood of their buying additional products like HIE and RCM tools from their existing vendors.

The results shouldn’t give any great pleasure to HIT vendors. All told, loyalty to inpatient EMR/HIT vendors fell 6%, from 81% to 75% committed clients. While it’s not horrible to have 75% truly happy with your product, this is not a metric you want to see trending downward.

When you combine these numbers with other signs of dissatisfaction, the picture looks worse. Roughly 25% of respondents said that they were only loyal to their vendor because they were forced to follow administrative directives. And as we all know, ladies and gents of the vendor world, you can’t buy love. These 25% of dissatisfied professionals will do their job, but they aren’t going to evangelize for you, nor will they be quick to recommend more of your products.

All is not bleak for EMR vendors, however. Some HIT vendors saw year-to-year growth in hospital client loyalty. Vendors with the biggest loyalty increases included Allscripts, Cerner, CPSI, NTT Data and athenahealth/RazorInsights.

By the way I noted, with a touch of amusement, that mega-costly Epic doesn’t appear on the latter list. Just sayin’.

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?

Are You Prepared For Healthcare Ransomware?

Posted on February 3, 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.

Earlier this month, a Texas hospital was hit with a particularly loathsome virus.  Leaders at Mount Pleasant, Tx.-based Titus Regional Medical Center found out on January 15 that a “ransomware” virus had encrypted files on several of the medical center’s database servers, blocking access to EMR data as well as the ability to enter data into the system.

In this kind of attack, the malware author demands a financial ransom to be paid for freeing up the data. TRMC didn’t disclose how much money the attacker(s) demanded, but it may have been an immense sum, because the hospital apparently thought that bringing in pricey security consultants and enduring several days of downtime was preferable to paying up. Although, they also probably realized the slippery slope of paying the ransom and also there’s no guarantee those receiving the ransom money will actually permanently fix the problem.

It would be nice to think that this was just a passing fad, but researchers suggest that it’s not. In fact, US victims of ransomware reported losses of more than $18 million in 14 months, according to an FBI report issued in June.

According to one news report, the average ransomware demand is about $300 per consumer. The amount demanded goes up, however, when business or government organizations are involved. For example, when a series of small police departments in Massachusetts, New Hampshire and Tennessee were hit with a ransomware attack tying up their key databases, they ended up paying between $500 to $750 to get back access to their data. One can only imagine what a savvy intruder familiar with the life-and-death demand for health information would charge to free up an EMR database or laboratory information system data store.

But the threat isn’t just to enterprise assets. Not only are hospital enterprise network attacks via ransomware likely to increase, these exploits could take place via wearables or medical devices in 2016, according to technology analyst firm Forrester Research. Such attacks don’t just use medical devices to reach databases; Forrester predicts that some ransomware attacks will disable the medical devices themselves.

Given how important mobile technology has become to healthcare, it’s worth noting that ransomware is increasingly targeting mobile devices as well. For example, a recent strain of Android virus known as Lockdroid ransomware is now afoot. While it has no direct healthcare implications, one of the things it does is threaten to send a user’s browsing history to friends and family unless they pay the ransom. The victim, who may get tricked into allowing malicious code to gain admin privileges on their device, could end up having their personal data — and perhaps data from an EMR app — sent wherever the attacker chooses.

It seems to me that the ransomware threat will push healthcare organizations to mirror their core data assets in new and heretofore unheard of ways. HIT departments will have to bring disaster recovery methods and network intrusion defenses to prevent the worst possible outcome — a hack that kills one or more patients — and quickly. Meanwhile, if a company specializing in protecting healthcare firms from ransomware doesn’t exist yet, I suspect one will exist by the end of 2016.

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.

Another Epic Loss: Iasis Upgrades To Cerner

Posted on January 20, 2016 I Written By

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

It’s too early to make a definitive claim, but I’m picking up some increasing evidence that Cerner is beginning to win out over Epic as some health systems upgrade. I’m not suggesting that Epic is ready to topple by any means, but it does seem that Cerner’s winning more potential matchups than they were before.

Want an example? Take the recent news that Iasis Healthcare will switch out its McKesson platform for the Cerner  Millenium EMR.  The 17-hospital system will spend $50 million to make the upgrade, which should be complete by March 2018. Most of the spending is ($35M+) is projected to come in fiscal 2016.

As I noted in an earlier post, Epic continues to grow at, well, an Epic pace. Reports suggest that Epic added 1,400 staffers last year, and the company seems likely to keep on pace in 2016. And as I previously noted, Epic software is either being used by or installed at 360 healthcare organizations in 10 countries, and also reported generating $1.8 billion in revenues for 2014.

But as the Iasis deal illustrates, Cerner is picking up some split-decision deals for what look like important reasons. One intriguing reddit post by captainnoob explains why his health system went with Cerner:

We whittled our choice down to 3 applications… McKesson Paragon, Epic, and Cerner. Those 3 were our forerunners as they were fully integrated and had modules to handle (almost) every service our facility provides. Ultimately the decision to go Cerner was based primarily on a combination of user input and cost of ownership.

  • User Input – We did numerous site visits with users from various clinical and managerial areas to talk workflow, ask questions such as how each product dealt with certain challenges we have already faced with McKesson, and view demonstrations in real-world conditions.
  • Cost of Ownership – Not just the cost of the product and implementation, but the cost of maintaining the product over 5-10 years.

I’m not sure why the competitive advantages Cerner has have shown up in higher relief recently. But my guess is that the wins Cerner is capturing have something to do with the psychology of EMR investment.

Going from a severely underpowered system — or none — to Epic involves taking a big leap of faith. How can you rationalize spending dozens or even hundreds of millions (or billions) on Epic? I’d argue that in essence, the ROI on that buy has been essentially unguessable. So the systems that have made a big Epic buy have had to justify their investment by pointing to big, still-intangible benefits like improved population health.

On the other hand, health systems that didn’t do Epic the first time, and have reasonably competent systems on board already, aren’t buying vision or reputation-ware. They aren’t pioneers, but instead, are looking for an economically and technically workable solution. In that circumstance, I know I’d be far more likely to go with a system with a lower total cost of ownership than an expensive Big Blue-style tool.

But these are just my theories. What do you think?  Is the investment tide turning toward Cerner, and why?

Rural Hospitals Catching Up In HIT Adoption

Posted on December 14, 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.

Historically, rural hospitals have lagged when it comes to health IT adoption. But according to at least one yardstick, the HIMSS EMR Adoption Model (EMRAM), rural facilities seem to have closed much of the gap.

Just a few years ago, many rural hospitals were barely at stage one of the model, which ranks facilities from Stage 0 (All three ancillaries not installed) to Stage 7 (Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP). Only two years ago, research suggested that rural and critical access hospitals were lagging far behind in meeting Meaningful Use criteria, and risked incurring penalties this year.

By the end of 2014, however, rural hospitals averaged a Stage 4 rating (CPOE, Clinical Decision Support (clinical protocols). This compares favorably with the 4.7 rank achieved by urban hospitals, and though academic/teaching hospitals were well ahead at a 5.4 ranking, that’s a much smaller difference than you might have seen even five years ago. Meaningful Use incentives, plus overall industry pressure to automate, seem to have done their job.

I’m pondering this, in part, because the CPSI acquisition of Healthland piqued my interest. CPSI picked up Healthland, a provider of rural and critical access hospital software, for $250 million. Given rural hospitals’ history of slow HIT adoption, I wasn’t sure what CPSI saw in Healthland, though the deal does bring revenue cycle management and an EMR for post-acute care facilities to the table.

Now that I’ve learned what progress the rural health IT market has seen, I’m no longer so skeptical. In fact, when you consider that the Healthland acquisition brings 3,300 post-acute customers that it didn’t have before, it seems like CPSI got a pretty nice deal.

Given the growing strength of the rural HIT market, I don’t think the Healthland buyout will be the last domino to fall here. I can easily imagine the giants — Cerner in particular — seeing their way clear to acquiring the combined CPSI/Healthland entity. Why Cerner? Well, if for no other reasons than having a ton of cash — and a more flexible attitude than Epic — I can imagine Cerner getting excited about rural access.

But even putting aside M&A dynamics, the news from rural markets is still intriguing. While having sophisticated health IT infrastructure is a plus anywhere, my guess is that it will be particularly powerful for rural and critical access hospitals. I hope that the growth of HIT capabilities brings a breath of fresh air — and the benefits of cutting-edge care management — to facilities that have traditionally gotten the short end of the stick.

HIM Professional Sing-Along – Let’s Help Doctors Be Doctors Again

Posted on October 28, 2015 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.

Last week, someone shared with me this amazing video and I have been singing along all weekend. There is quite a bit of skepticism in the lyrics to “EHR State of Mind” but it’s a clever expression of a physician’s view of the shortcomings of using EMRs. I enjoyed the creativity of this song and the video and I hope that these EMR issues are addressed soon as the frustrations he shared are definitely unintentional.

I have highlighted some of my favorite lines from the song below and wanted to share my interpretation from an HIM viewpoint.

“Notes used to be our story…narrative…but replaced with copy-paste…now a bloated ransom note”

This statement really resonated with me and my experiences over the past several years. I have definitely seen the decline in the quality of documentation since the install of the EMR. It doesn’t matter what vendor product is used, the reality is that the documentation has severely suffered because we’ve shifted the physicians’ attention to other workflow processes and EMR checkboxes. Copy and paste has reared its ugly head in far too many charts and we must stop the madness! HIM professionals have stepped in to assist with this by providing real-time auditing and feedback. Plus, HIM has provided assistance by enhancing documentation tools.

“Just a glorified billing platform with some patient stuff tacked on.”

I have heard similar statements on many different occasions. Some EMRs were structured around automating billing processes but that doesn’t mean they have to lack in clinical functionality. From the HIM perspective, we are accustomed to reimbursement and clinical documentation going hand in hand. Coding and billing processes were in need of an overhaul to make for more timely reimbursement and EMRs promised to do just that. Having the clinical documentation and data built into the same system was revolutionary and very exciting for us but it’s still a work in progress to optimize the clinical documentation.

“Uncle Sam promoted it but gone is the interop.” 

Wow- this is sad but true. I remember when I first heard about EMRs, HITECH, and Meaningful Use. I had dreams of sharing data with anyone involved in a patient’s care regardless of geographic location through an EMR health information exchange. Unfortunately, this hasn’t even been possible within the same zip code and sometimes not even among providers in the same organization. True interoperability is definitely missing from our EMR systems.

And lastly, “Crappy software some vendor made us.”

Out-of-the-box EMRs are not a one size fits all by any means. EMRs must be customized, trained on, and implemented in a fashion that works for each provider and healthcare system. The implementation process is not complete at “go-live”. The optimization (and most likely, re-build) period must continue indefinitely until the EMR workflows and data capture are ideal for all patient care, quality reporting, and billing purposes.

Do we really need a “new chart” or is enough optimization possible to get us where we need to be? We are constantly having discussions, starting committees, releasing updates, running reports, and everything in between with hopes that our enhancements will make the EMR more functional and meaningful. I value the feedback from physicians and other clinicians who are using the system daily because their intentions are to deliver the best patient care. EMR obstacles are unacceptable and must be fixed with the help of skilled EMR specialists, HIM and IT professionals, and workflow experts.

Enjoy the video by Dr. Z.

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