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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.

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

Antitrust In The Brave New EMR World

Posted on September 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.

Late last month, former Brigham and Women’s Hospital CEO Paul Levy made waves in the health IT world when he accused Epic of conspiring with Boston healthcare system Partners HealthCare.

In a post on his wryly-named Not Running a Hospital blog, Levy argues that Epic’s relationship with Partners raises antitrust concerns:

Here’s how it works.  Partners enters into a contract with Epic for the construction of an EHR for its facilities.  The two organizations go to the Partners-affiliated, but independent, medical practice groups and tell them that they have to install the Epic EHR–even if the EHR they have had for years is perfectly adequate for their purposes.  If a doctor’s practice asks why they can’t keep their old system, Epic makes clear that interoperability between its system and the practice’s legacy system is not feasible.  Meanwhile, to clinch the conversion, Partners also informs the local practices that failure to install the Epic system will foreclose those practices from participating in the favorable insurance contracting relationships it enjoys.  It is in this manner that the Epic-Partners actions box out the competition in this market.

In his article, Levy calls on Massachusetts Attorney General Maura Healey, and attorneys general of other states for that matter, to be on the lookout for similar deals between Epic and health systems elsewhere.

Interestingly, in other cases health systems accused of seeking excessive market power have used their Epic investment as a defense. For example, when its 2012 acquisition of Nampa, ID-based Saltzer Medical Group was challenged by the FTC, Boise health system St. Luke’s cited its $200M Epic system as a mitigating factor. Its lawyers asserted that St. Luke’s investment in effort was proof that the health system would be able to improve the region’s healthcare by better care coordination.

But the argument didn’t fly with the FTC, which didn’t believe that tying employed doctors to an EMR was needed to generate regional healthcare efficiencies. “Shared access to electronic medical records that St. Luke’s cited as a central benefit of the transaction can be achieved without an employment relationship or merger,” said Deborah Feinstein, director of the FTC’s Bureau of Competition at a speech given last year.

In my opinion, both Levy and Feinstein make excellent points. If Levy is right, it can easily be argued that Partners and Epic are engaging in questionable behavior, as it troubles at least this non-lawyer to see doctors strongarmed into using any particular EMR. And given that St. Luke’s was in the process of building a program to coordinate with unaffiliated physicians, it does seem that crying “we have Epic!” doesn’t address the problem.

But these are just bullet points. Overall, my sense is that neither state attorneys general nor the FTC and DoJ are sure how EMRs impact a health system’s market power, nor what constitutes anticompetitive behavior on the part of a vendor. I don’t know whether regulators don’t see EMR issues as a priority or are simply biding their time, but from my standpoint they are more than ripe for attack. What do you think?

Another Giant In Play: 3M Looking At “Strategic Alternatives” For HIS Unit

Posted on September 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.

Given the staggering number of EMR launches that took place in the wake of the Meaningful Use kickoff, mergers, sell-offs and business failures were quite predictable. Despite the feds’ doling out $30B in incentive dollars, even that wasn’t enough to keep hundreds of EMR entrants afloat.

It hasn’t been as clear what would happen to large vendors with HIT interests, given that they had enough capital to ride more than one wave of provider adoption. The field has just begun to shake out, with only a small handful of major transactions taking place. Recent plays by large tech players include Cerner’s $1.3B acquisition of Siemens Health Services, which included the Soarian EMR. There’s also ADP’s sale of EMR solution AdvancedMD to Marlin Equity Partners after previously acquiring e-MDs. Not to mention Greenway and Vitera Healthcare Solutions joining forces and Pri-Med acquiring Amazing Charts.

Another major move was announced this April at HIMSS 15, when GE Healthcare announced that it was phasing out its Centricity Enterprise product. According to news reports, the Enterprise product only generated 5% of the Healthcare division’s EMR revenue. I could keep going, but you get the point.

Now, 3M has joined the fray, announcing this week that it was “exploring strategic alternatives” for its HIS business, including spinning off or selling the unit.  (It’s also considering keeping its HIS business on board and investing in its future.)  The company, which has signed Goldman, Sachs & Co. as strategic advisor and investment banker, says that it will probably announce what direction it will head in by the end of the first quarter of next year.

On the surface, 3M Health Information Systems looks like a very solid business. The HIS unit, which is focused on computer-assisted coding, clinical documentation improvement, performance monitoring, quality outcomes reporting and terminology management, reportedly works with more than 5,000 hospitals, plus government and commercial payers. According to 3M, the HIS business generated trailing 12-month revenues of about $730M, and has sustained 10%+ compounded annual growth for 10 years.

That being said, it’s hard to say what the fallout from the ICD-10 switchover will be, and it’s not unreasonable for 3M to consider whether it wants to compete in the post-switchover world. After all, while the HIS unit seems to be quite healthy, it’s certainly faces stiff competition from several directions, including EMRs with integrated billing and coding technology. Also, the company may be saddled with outdated legacy infrastructure, which makes it hard to keep up in this new era of revenue cycle management.

By the end of the first quarter of 2016, 3M will have had a chance to see how its customers are faring post-ICD-10, and how its customers needs are shifting. 3M will also find out whether other HIS players with (presumably) newer technology in place are interested in doing a rollup with its business.

Truthfully, if 3M doesn’t think it can benefit from investing in the HIS unit, I’m not sure who else would benefit from doing so. In fact, I’d argue that 3M is undermining its chances at a deal by waffling over whether it plans to invest or divest; as I see it, this implies that the HIS unit will be on life support without a major cash infusion, which is not something I’d find attractive as an investor.  If nothing else I’d want to buy the unit at a firesale price! But I guess we’ll have to wait until March 2016 to see what happens.

Under the Hood of Medical Devices

Posted on September 11, 2015 I Written By

The following is a guest blog post by Kevin Phillips, Vice President – Marketing and Product Management at CapsuleTech.
Value of Medical Device Data

When it comes to medical devices, most people think of patient monitoring and physiologic data such as HR, SPO2, respiration rate waveforms and physiologic alarms. But there’s a lot more “under the hood” of a device – a lot more than just physiologic data that, when applied in new ways, can contribute to patient safety efforts and help with operational efficiencies.

Under the hood are three types of data.  The first, and most often understood and used, is patient data that provides information on the physiologic status of the patient; a snapshot, if you will, of a patient’s condition at a given moment in time. The second type of data is treatment details.  These details provide a comprehensive view of treatments being administered to a patient, and include the names of drugs or anesthetic agents, drug concentration, the volume to be infused, or volume of air being delivered via a ventilator.  The third type of data is about the devices themselves. This information includes not only modes of operation, technical alarms, and battery level, but also data, such as firmware versions and unique device identifiers, that is useful to the clinical engineers responsible for maintaining these devices.

Of course, all of this data is meaningless without context.  This “contextual device data” can be added by external systems such as an EMR or by Capsule’s SmartLinx Medical Device Information System®. We define context as key information for each device: how the device is being used; where it is located; to which patient it is connected; and the identity of the primary clinician responsible for this patient. We also want to know information about the device itself including its unique device identifier, synchronized time (e.g. measurement time, device time, and NTP server time). Last, of course, are the clinical observations of the patient.

Today, only a fraction of this data…maybe 10%…is being used by a hospital; what is being used is typically only that data specified by the hospital by its EMR.  And while not all of the remaining 90% of the data is useable in some cases, there is a fair amount of significant value if mined and delivered to the appropriate system or user when it is needed.  Some examples include:

  • Alarm Management Systems – Well-documented patient safety risks posed by the failure to adequately address medical device alarms management by publications such as ECRI has led the Joint Commission to create a National Patient Safety Goal. This goal requires all hospitals to have a policy in place to manage alarms appropriately by 1/01/2016.  This has driven a demand for medical device data like near real-time notification of high priority physiologic and technical alarms from each device.  The art to these data integrations is close collaboration to deliver the proper alarms so not to overwhelm the clinician with nuisances (low priority alarms).
  • Device utilization – While solutions exist to help identify the location of expensive, high-maintenance devices, determining which devices are in use is difficult. Providing timely and appropriate device data to biomedical teams can ensure optimal device management, use and health, easing patient throughput and contributing to patient safety and care.
  • Clinical Decision Support Systems – Whether hospitals have created their own algorithms or purchased a turn-key solution, CDSS’s require high frequency physiologic medical device measurements to properly power their specific algorithms to enable them to identity patients at risk of sepsis or deterioration.
  • Patient Surveillance Applications – Automated patient surveillance helps clinicians to remotely wade through vast information stores to quickly discern data of the greatest value. With the addition of real-time device data, patient surveillance applications can better identify data clusters and trends consistent with patient deterioration and specific disease conditions, prompting clinical intervention.
  • Asset Management – While asset-tracking solutions can help identify the current location of devices, determining which devices are in use or underutilized is difficult. Devices offer a range of built-in operational checks, or support remote monitoring to ensure device readiness and status of any required supplies. The availability of this data to biomedical teams will ensure optimal device management and health, easing patient throughput and boosting patient safety and care.

So what’s under the hood of all of your medical devices?  Probably a whole lot more that you ever imagined that can be of immense value throughout your hospital. Why don’t you take a look today to see what value can be derived.

About Kevin Phillips
Kevin Phillips is the Vice President – Marketing and Product Management at CapsuleTech with over 10 years of experience in various roles within the healthcare, medical device and diagnostic industries. His career has been focused on new product development, product marketing, market analysis, strategic alliances, corporate operations, and sales. Prior to joining Capsule, Mr. Phillips held positions at TransMedics and PathoGenetix (formerly US Genomics). His career has been focused on new product development, product marketing, market analysis, strategic alliances, corporate operations, and sales.

EMR Vendors Slow To Integrate Telemedicine Options

Posted on August 27, 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.

Despite the massive growth in demand for virtual medical services, major EMR vendors are still proving slow to support such options, seemingly ceding the market to more agile telemedicine startups.

Independent telemedicine vendors targeting consumers are growing like weeds. Players like Doctor on Demand, NowClinic, American Well and HealthTap are becoming household names, touted not only in healthcare blogs but on morning TV talk shows. These services, which typically hire physicians as consultants, offer little continuity of care but provide a level of easy access unheard of in other settings.

Part of what’s fueling this growth is that health insurers are finally starting to pay for virtual medical visits. For example, Medicare and nearly every state Medicaid plan also cover at least some telemedicine services. Meanwhile, 29 states require that private payers cover telehealth the same as in-person services.

Hospitals and health systems are also getting on board the telemedicine train. For example, Stanford Healthcare recently rolled out a mobile health app, connected to Apple HealthKit and its Epic EMR, which allows patients to participate in virtual medical appointments through its ClickWell Care clinic. Given how popular virtual doctor visits have become, I’m betting that most next-gen apps created by large providers will offer this option.

EMR vendors, for their part, are adding telemedicine support to their platforms, but they’re not doing much to publicize it. Take Epic, whose EpicCare Ambulatory EMR can be hooked up to a telemedicine module. The EpicCare page on its site mentions that telemedicine functionality is available, but certainly does little to convince buyers to select it. In fact, Epic has offered such options for years, but I never knew that, and lately I spend more time tracking telemedicine than I do any other HIT trend.

As I noted in my latest broadcast on Periscope (follow @ziegerhealth), EMR vendors are arguably the best-positioned tech vendors to offer telemedicine services. After all, EMRs are already integrated into a hospital or clinic’s infrastructure and workflow. And this would make storage and clinical classification of the consults easier, making the content of the videos more valuable. (Admittedly, developing a classification scheme — much less standards — probably isn’t trivial, but that’s a subject for another article.)

What’s more, rather than relying on the rudimentary information supplied by patient self-reports, clinicians could rely on full-bodied medical data stored in that EMR. I could even see next-gen video visit technology which exposes medical data to patients and allows patients to discuss it live with doctors.

But that’s not how things are evolving. Instead, it seems that providers are largely outsourcing telemedicine services, a respectable but far less robust way to get things done. I don’t know if this will end up being the default way they deliver virtual visits, but unless EMR vendors step up, they’ll certainly have to work harder to get a toehold in this market.

I don’t know why so few EMR companies are rolling out their own virtual visit options. To me, it seems like a no-brainer, particularly for smaller ambulatory vendors which still need to differentiate themselves. But if I were an investor in a lagging EMR venture, you can bet your bottom dollar I’d want to know the answer.