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Which Health IT Is Poised For Hospital Growth?

Wondering which hospital applications are likely to be popular in the near future?  According to HIMSS Analytics, contenders include patient portals, clinical data warehousing/mining, and radiology barcoding software are poised for faster uptake in hospitals.

To gather this information, HIMSS Analytics did an analysis of the current market penetration and projected five-year sales trajectory each application considered in its Electronic Medical Record Adoption Model (EMRAM) report.  Researchers found that first-time purchases of these advanced EMR applications should grow dramatically in hospitals across the U.S.

According to Healthcare Informatics, there are good reasons why each of these three technology should be on the upswing in hospitals.  For example, the patient portal market is growing because it’s tied to Meaningful Use Stage 2 requirements.  Expected growth in sales of clinical data warehousing/mining technology is tied to the need to leverage data held in EMRs, and it’s that that sales increases in and radiology barcoding are probably associated with patient safety initiatives.

Meanwhile, the report also noted that several basic applications which have already saturated the hospital market will be responsible for a high-volume IT replacement sales, including laboratory barcoding, pharmacy management systems and information systems for radiology and laboratorydepartments.

The report from HIMSS seemingly doesn’t take mobile applications and systems into account — I’d argue because they are not yet seen as enterprise-level tools — but I think hospitals will be spending more on mobile technology than anticipate over the next few years, as tablets and smartphones become a permanent part of their infrastructure.  Just how fast that will happen remains to be seen, but it will happen.

January 21, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

The CIO’s Guide to HIPAA Compliant Text Messaging

Yesterday I wrote a piece on EMR and EHR where I talk about why Secure Text Messaging is Better Than SMS. I think it makes a solid case for why every organization should be using some sort of secure text messaging solution. Plus, I do so without trying to use fear of HIPAA violations to make the case.

However, you can certainly make the case for a secure text messaging solution in healthcare based on HIPAA compliance. In fact, the people at Imprivata have essentially made that case really well in their CIO Guide to HIPAA Compliant Text Messaging. This is well worth a read if you’re in a healthcare organization that could be at risk for insecure texting (yes, that’s every organization).

They break down the path to compliance into 3 steps:

  1. Policy – Establish an organizational policy
  2. Product – Identify and appropriate text messaging solution
  3. Practice – Implement and actively managing the text messaging solution.

Texting is a reality in hospitals today and the best solution isn’t suppression, but enabling users with a secure solution. The checklists in the CIO Guide to HIPAA Compliant Text Messaging provide a great foundation for making sure your organization is enabling your users in a HIPAA compliant manner.

January 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Epic to Epic Conversion

Gabriel Perna has a great article on Healthcare Informatics discussing an EHR conversion that I hadn’t considered. What happens when a hospital system acquires another hospital system and they both use the Epic EHR? Here’s the challenge as described in the article:

“As we got into it, we realized Epic had done [a conversion from] IC Chart [InteGreat from Med3000] before, they had done Cerner-to-Epic conversions, they had done McKesson-to-Epic conversions. They had done those before, and they do them well. They hadn’t done Epic-to-Epic before. That was the area where they were least experienced in. It was a lot more work to do,” says [Bob] DeGrand, who assumed the position of CIO [of Froedtert Health] in January of 2009, a few months after the West Bend affiliation became official.

As we continue on our path of hospital system consolidation, this is going to become more and more of an issue. As those familiar with Epic know, every Epic installation is unique. I was recently told by someone that even within the all Epic Kaiser there are multiple Epic installations and they have a challenge communicating with each other. Now think about what that means if you’re trying to merged two different Epic installations.

The article also points out that one of the biggest challenges in a merge like this is overlapping patients and ensuring that you merge them properly. Patient identity is a big challenge in any hospital system, but even more important when you’re looking to merge two large hospital systems that have relatively close proximity with similar patient populations.

I’d be interested to hear from other people who might have gone through an Epic to Epic conversion. What challenges did you face? Would you have rather had a Cerner to Epic conversion?

December 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Kaiser Permanente Branch Joins Epic Network

Though it apparently held out for a while, Kaiser Permanente Northern California has signed on to Epic Systems’ Care Everywhere, a network which allows Epic users to share various forms of clinical information, Modern Healthcare reports.

Care Everywhere allows participants to get a wide range of patient data, including real-time access to patient and family medical histories, medications, lab tests, physician notes and previous diagnoses. The Care Everywhere network debuted in California in 2008, and has since grown to a national roster of more than 200 Epic users.

Many of the state’s major healthcare players are involved, including Sutter Health, as well as prominent regional players such as Stanford Hospital and Clinics, USCF Medical Center and UC Davis Health System, according to Modern Healthcare. Kaiser Permanente Southern California also participates in the network.

According to Epic, the Care Everywhere system allows patients to take information with them between institutions whether or not both institutions use the Epic platform. Information can come from another Epic system, a non-Epic EMR that complies with industry standards, or directly from the patient.

But of course, the vendor likes to see Epic-to-Epic transmission best, as it notes on the corporate site: “When an Epic system is on both sides of the exchange, a richer data set is exchanged and additional conductivity options such as cross-organization referral management are available.”

Care Everywhere also comes with Lucy, a freestanding PHR not connected to any facility’s EMR system. According to Epic, Lucy follows patients wherever they receive care, and gathers data into a single source that’s readily accessible to clinicians and patients. Patients can enter health data directly into Lucy or upload Continuity of Care Documents from other facilities.

While connecting 200+ healthcare organizations together is a notable accomplishment, Care Everywhere is not going to end up as the default national HIE matter how hard Epic tries. As long as the vendor behind the HIE (Epic) has a strong incentive to favor one form of data exchange over another, it cuts down the likelihood that you’ll have true interoperability between these players. Still, I’ve got to admit it’s a pretty interesting development. Let’s see what healthcare organizations have to say that try to work with Care Everywhere without owning an Epic system.

P.S. It’ll also be interesting to see whether Epic is actually “best” for ACOs, as a KLAS study of a couple of years ago suggested. More recent data suggests that best-of-breed tools will be necessary to build an ACO, even if your organization has taken the massive Epic plunge.

December 26, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Cerner Forced To Pay Out Large Settlement To Customer

Cerner has struck a settlement agreement with one of its customers which will force the giant IT vendor to take significant charge against its fourth-quarter earnings.

The client, Trinity Medical Center of Minot, N.D., claimed last year that the patient accounting software sold by Cerner in 2008 was defective and didn’t deliver on the promised business benefits.

In the suit, the medical center asked for $240 million in damages, while Cerner only estimated damages of $4 million.  To settle the matter, the two parties agreed to go into arbitration, according to a report in the Wall Street Journal.

While the amount of the settlement was not disclosed in court filings, Cerner clearly got its clock cleaned. The vendor issued a statement saying that it “strongly disagreed” with the amount the hospital was awarded.

As a result of the arbitration settlement, Cerner will take a charge of $0.18 to $0.19 per share for the quarter ending Dec. 23, 2013. Clearly, Cerner came out on the wrong side of the deal, and then some. And it’s not used to losing. The vendor’s statement also noted that this settlement was “the only material judgment against Cerner in its 34-year history.”

While both Cerner and Wall Street will get over this matter, it’s still something of a landmark in the IT vendor business. Most of the time, IT vendor contracts have customers so tied up in knots that they can’t even speak about their experiences with the product, much less take the vendor to court for for poor product performance.

December 17, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

ICUs Can Improve Survival, Speed Discharges Using Telehealth

ICUs can boost patient survival rates and speed ICU and hospital discharge rates if they use tele-ICU technologies, a study published  in CHEST Journal concludes, according to a report in iHealthBeat.

The study involved researching the impact of tele-ICU technologies in 56 ICUs that were part of 32 hospitals and 19 health systems, tracking them over a five-year period, according to iHealthBeat. The project, which was led by Craig Lilly, director of UMass Memorial Medical Center’s eICU Program, involved more than 110,000 patients.

The hospitals involved in the study used the Phillips Healthcare eICU technology, a comprehensive set-up which included bidirectional audio and video equipment, population management tools and real-time and retrospective reporting tools.

The study looked at how ICU doctors created treatments based on best practices, and responded to patient alerts and alarms, iHealthBeat notes.

Researchers found that patients who received care in hospitals using telemedicine were 26 percent more likely to survive in the ICU than patients in units that didn’t use tele-ICU technologies. It also found that patients were 16 percent more likely to survive their hospitalization than their counterparts who didn’t receive tele-ICU services.

What’s more, researchers found that patients in ICUs using telemedicine saw 20 percent faster discharges in the ICU and 15 percent faster hospital discharges.

This research strongly suggests that tele-ICU is maturing, and should be taken seriously as part of a hospital’s treatment arsenal.  In fact, your hospital might want to take a look at a new set of best practices created by the New England Healthcare Institute designed to make tele-ICU more scalable and accessible to hospitals.

Ultimately, the ideal is to connect telemedicine — and other remote sources of data — to hospital EMRs, allowing a new level of collaboration between far-flung clinicians. But in the mean time, it seems that tele-ICU can offer great benefits even if it creates a data silo for the time being.

December 10, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

What Can Go Wrong With An Epic Implementation

With Epic owning the lion’s share of new EMR implementations — it has as many in progress or planned as all other major vendors combined — it’s good to stop and look at just what can go wrong with an Epic implementation.

After all, while Epic installations are a fact of life, all of the news they generate isn’t good. In fact, a growing number of stories of botched Epic installs and institutional fallout are beginning to mount.

In an effort to do learn more about Epic’s strengths and weaknesses, researchers at The Advisory Board Company interviewed some of Epic’s most experienced U.S. hospital customers, as well as some of the busiest Epic implementation consultants, writes senior research director Doug Thompson.

As Thompson points out, the problems Advisory Board identified could impact any big EMR install, but with Epic in the lead, it doesn’t hurt to focus on its products specifically.  (By the way, according to the Advisory Board, there were 194 Epic installs in process or contracted for 2012 and 2013; the closest competitor, MEDITECH, had 59 and Cerner came in at 55.)

So what’s behind the stumbling? Thompson names several limitations to Epic’s own approach to implementation, including the following:

* Its young implementation staffers may be enthusiastic, but some lack operational experience in hospitals or medical practices, which means they rely heavily on Epic’s standard methods and tools –and that may not be adequate for some situations.

* Though Epic’s recommended implementation staffing numbers are higher than that of most other EMR vendors, their estimate nonetheless falls short often by 20 percent to 30 percent of the need.

*Epic’s “foundation” (model) installation plan limits customization or extensive configuration until after the EMR has gone live, which can lead to less physician buy-in and end-user cooperation.

To address these concerns, Thompson offers fourteen techniques to help hospitals get the value they want.  Some of my favorites include:

Begin with the end in mind: Make sure your facility has specific, measurable benefits they hope to achieve with your Epic implementation, and prepare to measure and manage progress in that direction.

Governance: Make sure you assign appropriate roles and responsibilities in managing your Epic rollout and ongoing use. While IT will serve as the linchpin of the project, of course, it’s critical to make sure the appropriate operations leaders have a clear sense of how Epic can and should affect their areas of responsibility.

Get outside input on project staffing: While Epic is upfront about the need for extensive staffing in its implementation, as noted its estimates still come in rather low. It’s a good idea to get in objective outside estimate as to how big the project staff really needs to be.

For more information, I highly recommend you read the full Advisory Board brief. But in short, as  the report concludes, it seems that relying too much on Epic’s approach, staff and tools can lead to problems. Surprised?

December 9, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Can Big Data Do What Vendors Claim?

There’s no doubt about it — the air is ringing with the sounds of vendors promising big things from big data, from population health to clinical support to management of bundled payments. But can they really offer these blessings?  According to enterprise health IT architect Michael Planchart (known to many as @theEHRGuy), there’s a lot of snake oil sales going on.

In his experience, many of the experts on what he calls Big Bad Data either weren’t in healthcare or have never touched healthcare IT until the big data trend hit the industry. And they’re pitching the big data concept to providers that aren’t ready, he says:

  • Most healthcare providers haven’t been collecting data in a consistent way with a sound data governance model.
  • Most hospitals have paper charts that collect data in unstructured and disorganized ways.
  • Most hospitals — he asserts — have spent millions or even billions of dollars on EMRs but have been unable to implement them properly. (And those that have succeeded have done so in “partial and mediocre ways,” he says.)

Given these obstacles,  where is big data going to come from today? Probably not the right place, he writes:

Well, some geniuses from major software vendors thought they could get this data from the HL7 transactions that had been moving back and forth between systems.  Yes, indeed.  They used some sort of “aggregation” software to extract this data out of HL7 v2.x messages.  What a disaster!  Who in their sane mind would think that transactional near real time data could be used as the source for aggregated data?

As Planchart sees it, institutions need quality, pertinent, relevant and accurate data, not coarsely aggregated data from any of the sources hospitals and providers have. Instead of rushing into big data deals, he suggests that CIOs start collecting discrete, relevant and pertinent data within their EMRs, a move which will pay off over the next several years.

In the mean time, my colleague John Lynn suggests, it’s probably best to focus on “skinny data” – a big challenge in itself given how hard it can be to filter out data “noise” — rather than aggregate a bunch of high volume data from all directions.

December 6, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Deploying WiFi For Clinicians, Hospital Guests A Complex Problem

These days, offering WiFi for both hospital visitors and clinicians is pretty much de rigeur. The problem is, clinicians need different things from their Wi-Fi connection than consumers do. And as a recent story in Healthcare IT News notes, that can make it difficult to keep up with everyone’s demands.

According to Ali Youssef, senior clinical mobile solutions architect at Detroit-based Henry Ford Health System, maintaining a wireless network that suits everyone’s needs is “moving target.”

Youssef was responsible for planning and implementing the HFHS wireless network, which included expanding coverage from 4 million to 8 million square feet. What’s more, the network rollout had to take into account the needs of the HFHS enterprise EMR system, according to the HIN piece.

For Youssef, one of the most difficult problems health IT managers face in this situation is provisioning bandwidth appropriately to all the different types of devices that will share the bandwidth.

Not surprisingly, Youssef believes that one of the most important ways to see that everyone has enough bandwidth is regular contact with the system’s clinicians.

In some situations, clinicians may need far more bandwidth then the IT department had anticipated, for example, where clinician is launching a new project fueled by grant money, notes the Healthcare IT News piece. (We’re also increasingly see a growing list of wireless medical devices, such as wireless glucometers, edge into mainstream clinical care.)

To cope with these rapidly changing demands, Youssef recommends planning for a high level of wireless system redundancy and conducting site surveys.

And in what may be a more difficult challenge, he recommends that network architects keep continuous tabs on what types of devices are going to be used, and testing them see how they behave on their health system’s network.

Youssef didn’t offer any detailed advice on how to accommodate hospital visitors in this story, but clearly, they will pose a significant challenge to any hospital network architect as well.

Particularly as apps become part of patients’ health system experience, network architects will need to bear consumer experience of the network in mind as well. It will be interesting to see, over the next few years, whether consumer wireless health use demands a fresh approach to network architecture generally.

December 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Next Year, Hospitals Should Report Quality Data Electronically

While it’s not absolutely necessary, hospitals that have enough resources should prepare themselves to report clinical quality measures electronically to CMS in 2014. That, at least, is the advice two Advisory Board Co. consultants had to share in a recent blog post, Information Week reports.

Doing so will save them a great deal of time on manual chart abstraction. What’s more, it will prepare them for the electronic reporting mandate CMS is expected to issue after 2014, according to consultants Robin Raiford and Anantachai Panjamapirom.

Choosing the electronic reporting option for next year has other some advantages, too. Hospitals that do so are taking the next step in aligning the reporting of CQMs in the CMS Inpatient Quality Reporting program and Meaningful Use, they remind us.

Hospitals that choose to report electronically next year can submit patient-level data digitally on the 16 CQMs required for Meaningful Use; meanwhile, they’ll have that data count toward the IQR requirement that they report on 57 CQMs that include those 16 measures.

Not only that, they’ll only have to report electronically on the aligned measures for a single quarter, though the IQR reporting. Is the full calendar year.

As the consultants point out, hospitals can continue to report CQMs separately for each program. But it multiplies the work they must do. In that case, they’ll have to use manual chart abstraction to collect data for all the CQMs in the IQR program. And they’ll have to submit aggregated quality data by attestation to the Meaningful Use program.

The reward for submitting electronically can be great. According to CMS’s own calculations, in the 2014 final rule for the Inpatient Prospective Payment System, hospitals that report electronically will save 800 hours on average over those that engage in manual chart abstraction.

In theory, Information Week notes, this should be a “no-brainer” for hospitals, but at least during the Meaningful Use Stage 1 reporting period, many hospitals found it difficult to impossible to harvest the quality data they needed electronically.

But now, with hospitals at Meaningful Use Stage 2, data harvesting problems have largely been resolved, Raiford told the magazine. By the fiscal fourth quarter, Raiford expects to see far more hospitals reporting electronically.

December 2, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.