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Health IT Haiku

Now for something completely different, folks. Here’s some haiku verses (5-7-5 syllable scheme) on EMR and HIT issues. I’m hoping y’all jump in and give it a try next.

EMR cutover
Could it be that all our work
Comes down to this day?

Everyone freaks out
EMR has gone off line
Painful nine seconds

Meaningful Use is
Years of pain and suffering
For a bite-sized check

Can’t write haiku on
interoperabili-
ty, or can you now?

Elegant, simple
EMR interface is
Rarer than diamonds

Fifty million spent
Putting in their EMR
Which they then threw out

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May 20, 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.

Filed Under: Community Hospitals  Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Meaningful Use
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Survey: Confusion Slowing Meaningful Use Compliance

While Meaningful Use is likely to spur improvements in health IT, confusion over regulations — and the need to pursue other pressing HIT projects — are slowing down MU compliance, according to a new study.

The survey was conducted by Stoltenberg Consulting, which spoke with health IT managers, clinicians, HIT vendors and government agencies that attended this year’s HIMSS event.

Researchers asked which areas in which HIT will achieve the biggest improvements over the next 12 months.  The biggest group (35 percent) named Meaningful Use, while 19 percent said health information exchange, clinical integration and mobile health were due for the most growth.

When asked what might hold them back from meeting Meaningful Use requirements, 29 percent said confusion and/or ambiguity in the regulations were a challenge. Others named competing health IT projects (23 percent) and a lack of key resources such as funding, IT skills, talent and time (17 percent).

The survey also asked respondents what issues were likely to dominate HIT discussions this year.  Respondents favored health information exchange (62 percent), followed closely by mobile health (58 percent) and clinical analytics (54 percent).

As part of the survey, Stoltenberg also asked survey respondents which problems HIT executives would most likely attempt to solve with the help of a specialized IT consulting firm. The responses included ICD-10 (25 percent), Meaningful Use (25 percent), clinical and business intelligence (23 percent), cloud computing (21 percent) and CPOE/clinical systems implementation (20 percent).

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May 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.

Filed Under: Clinical Decision Support  Cloud EHR  Health Information Exchange  HIE  Hospital Business Intelligence  Hospital EHR  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Vendor  Hospital Healthcare IT  Hospital IT Systems  Meaningful Use  Mobile Technology
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EMRs Have Certifications Yanked

A California EMR developer has become the first to have its certification for Meaningful Use taken away by the ONC.

EHRMagic-Ambulatory and EHRMagic-Inpatient, both of which were developed by Santa Fe Springs, Calif.-based EMRMagic, failed to meet certification requirements, reports EMR Thoughts.

The de-certification process began when ONC and ONC-authorized certification body InfoGard Laboratories were notified that the EHRMagic products didn’t meet Meaningful Use certification requirements.

InfoGard Laboratories analyzed the information sent along with the notification and contacted the vendor. It then began the process of ONC-ACB required surveillance activities, according to HIN. At that point, InfoGard decided to test the two products for compliance with certain requirements.  EHRMagic’s products were then retested, and failed to meet criteria for Meaningful Use certification.

Fortunately for the company’s customers, no providers had yet attempted Meaningful Use attestation using these products. One can only imagine the frustration they would have faced if they attempted to attest in good faith and found out that the EMR product they were using wasn’t capable of supporting MU certification.

I’m left wondering whether providers would have grounds for a lawsuit against the offending vendor if they attempted certification with a product that didn’t support Meaningful Use, particularly if the vendor had any idea that this might be the case.

Realistically, it seems likely at some point in the future, some provider will be left high and dry by a certified product that shouldn’t have gotten the go-ahead.  My guess is that things will get nasty pretty quickly!

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April 29, 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.

Filed Under: Hospital EHR  Hospital EHR Company  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital Healthcare IT  Hospital IT Systems  Meaningful Use
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Growing Number Of Children’s Hospitals Use EMRs

The number of children’s hospitals with EMRs in place — and compliant with Meaningful Use — has increased substantially over the last few years, though minor teaching and nonteaching institutions are not as far along, according to a new study appearing in the journal Pediatrics.

The study, which compares data on EMR adoption from 2008 with data on 2011, collected data from 126 children’s hospitals.  Researchers calculated EMR adoption rates by using existing definitions of the key functionalities which make up an EMR.  The study also looked at Meaningful Use compliance, which it evaluated by by checking whether a given hospital could meet 12 core Meaningful Use criteria.

The study found that between 2008 and 2011, the number of childrens’ hospitals with an EMR grew from 21 percent to 59 percent.  But even using 2011 data, only 29 percent of children’s hospitals had demonstrated that they could meet the 12 core criteria used as a Meaningful Use proxy.

All told, EMR adoption rates and Meaningful Use compliance rates were much higher for childrens’ hospitals than for adult hospitals as a whole.  However, the results were similar for adult and childrens’ teaching hospitals.

These results square well with an early 2012 report by HIMSS Analytics which looked at Meaningful Use Stage 1 compliance among hospitals. HIMSS found that teaching hospitals were one of the hospital types most likely to have embraced Meaningful Use.

The question, for me, is when childrens’ hospitals are going to step up further in their Meaningful Use efforts. I don’t know about you, but to me 29 percent compliance isn’t terribly impressive.

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April 24, 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.

Filed Under: Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Meaningful Use
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Senators Question Meaningful Use EHR Investment

Six Republican Senators have released a report arguing that there’s no evidence the $32 billion spent on Meaningful Use is delivering the benefits it was designed to offer.

The report, entitled “Reboot: Re-Examining The Strategies Needed to Successfully Adopt Health IT,” was released by Senators Thune, Alexander, Roberts, Burr, Coburn and Enzi. In the report, these Senators dig into the implementation of Meaningful Use and critiquing how the money’s being spent.

The Senators’ concerns are as follows:

* Interoperability:  They argue that HITECH is not doing enough to promote interoperability.  The Senators say that incentive payments are being doled out without clear evidence that providers can connect with one another.

* Cost savings:  Health IT has been promoted as a tool for taking costs out of the health system, and, the Senators concede, is projected by the CBO to save Medicare and Medicaid $12.5 billion through 2019.  However, they note that some reports state that health IT may have accelerated ordering of unnecessary care as well as increased billing per procedure.

* Oversight:  The Senators cite reports from the HHS Inspector General and the GAO which seem to suggest that the Administration hasn’t done enough to prevent fraud and waste in the Meaningful Use program.

* Security:  The report argues that Meaningful Use standards don’t do enough to secure private patient data; they cite reports from the HHS OIG claiming that Medicare and ONCHIT are “lax”  in this area.

* Sustainability:  When the Meaningful Use money runs out, will providers still be able to keep their health IT equipment running? In the report, the Senators suggest that the ongoing cost of maintaining EMRs and other health IT may be too much to bear, especially for small practices, when the money runs out.

As with most reports of this kind, I’d argue that there’s some truth mixed in with some partisan posturing. For example, I can see where Senatorial observers might be frustrated with the pace of interoperability efforts. On the other hand, I think the sustainability argument may be a straw horse;  my gut tells me that once a practice or hospital has spent years implementing an EMR, they’re not going to drop it like a hot potato when the incentives stop coming.

What do you think of the Senators’ critique?

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April 22, 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.

Filed Under: Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Meaningful Use
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Who Really Pays For EMRs?

Hospitals are adopting EMRs at a rapid clip, going through money like water in an effort to capture Meaningful Use incentives.  The idea, from a federal policy perspective, is that the EMRs will save enough money to pay for themselves while improving care on many levels.  This all sounds great, and many people are counting on this outcome.

The thing is, to date there’s been little evidence that such a welcome transformation is taking place, even within hospitals that have achieved high levels on  the HIMSS EMR adoption scale.  Just look at how things are playing out:

* Doctors and nurses may find some EMR implementations actually help them with their work, but you’re not hearing about new bursts of productivity.

* To date, the evidence has been mixed at best that EMRs generate savings through improved care efficiencies.

* While nobody expected EMRs to immediately take back the $750 billion the Institute of Medicine estimates is wasted per year in the healthcare system, one might hope to see signs that EMRs can someday move the needle — and  largely, we’re not.

So, who will ultimately pay for hospitals’ huge investments in EMRs?  It seems that it won’t be improvements in efficiency, productivity, waste or even morale, so the money has to come from somewhere.

From an economics perspective, the most obvious conclusion is that the consumer will be paying the tab. After all, service  providers simply raise prices when their expenses increase, right? In this case, not really. Given the fact that so much of hospital care is financed by insurance companies, the analysis becomes more complicated.

Insurance companies will definitely pass on costs to consumers, or restrict access, if a particular service becomes too expensive. But EMRs are a hospital operating cost, one which can’t be targeted neatly by insurers by raising a deductible or requiring a pre-approval process of some kind.

What about insurance companies absorbing the cost of EMRs?  My best guess is that hospitals will not be able to get much — if any — extra reimbursement just because they’ve invested in EMR systems.

So where in this shell game does the cost end up?  On the hospitals themselves. And that’s not a pretty picture, especially for community hospitals without economies of scale enjoyed by their bigger brethren.  My guess is that even with incentives being paid, we’re not far away from EMR-related hospital bankruptcies or layoffs entering the picture.

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April 5, 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.

Filed Under: Community Hospitals  Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Meaningful Use
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Best Of Breed Systems Lead In Battle For Meaningful Use Dollars

This week, Modern Healthcare published a very interesting analysis of ONC and CMS data on which vendors were used for Meaningful Use attestation.  The results suggest that the battle for market dominance may be closer than it looks when it comes to producing results that count. Perhaps more importantly, the data suggests that best-of-breed systems may have a stronger foothold than unified systems (see more below).

According to Modern Healthcare, four vendors stood out as leader in the complete inpatient EMR market:

* Epic Systems, with 370 hospitals customers, or 17.9 percent of 2,071 hospitals which have attested using one of the four

* Meditech, with 323 hospitals, or 15.6 percent

* CPSI, with 313 hospitals, or 15.1 percent

* Cerner Corp., with 208 hospitals, or 10  percent

All told, these top four players have sold 1,214 hospitals a complete inpatient EMR system. That’s represents 58.6 percent of all systems sold to hospitals that have gotten a Medicare incentive check using a complete inpatient EMR. The top 10 vendors swelling such systems, meanwhile, have sold them to 1,902 hospitals, owning almost 92 percent of this niche, Modern Healthcare notes.

It’s important to note, however, that best-of-breed implementations have won even more Meaningful Use dollars, the analysis suggests.  In fact, 2,438 hospitals using modular inpatient EMRs have achieved Meaningful Use. According to Modern Healthcare research, three developers lead the modular inpatient EMRs hospitals have used for this purpose:

* Meditech, with 637 hospitals, or 26.1 percent

* Cerner, with 530 hospitals, or 21.7 percent

* HCA Information & Technology Services, with 274 hospitals, or 11.2 percent

Collectively these vendors account for 59.1 percent of modular inpatient EMR market, the analysis shows.

I thought it was quite noteworthy that a larger share of hospitals are using best-of-breed inpatient systems to achieve Meaningful Use than complete inpatient systems. It would be interesting to find out if interoperability was one of the reasons hospitals are making this choice — since we know that the big vendors are shaky on the concept at best.

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April 1, 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.

Filed Under: Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Hospital IT Systems  Meaningful Use
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Again, With More Gusto: Could Meaningful Use Incentives Be Slashed?

As readers of this publication know, your editor has previously held forth on the issue of whether Meaningful Use incentive funds could be cut in the current rush to snip budgets.

With the sequester seemingly moving forward, though, and continued budget-cutting fights underway, it seems a good time to address the matter again.  So I’ll plow on, partly in response to a nicely-detailed editorial by Tom Sullivan, editor of Government Health IT.

In his editorial, Sullivan notes that 40 percent of its readers expect health IT’s bipartsan support to continue, while 25 percent argue that opposition to health IT spending is brewing on the Hill. (Another 36 percent of his readers argued that health IT momentum would continue whether or not government keeps on doling out incentive funds.)

But are his readers right about the political climate?  To get more insight, Sullivan speaks to some authorities on the subject of health IT spending, including Scott Lundstrom, group vice president of consultancy for IDC’s Health Insights Unit.

In his comments, Lundstrom points out that while there’s probably enough support for health IT capabilities — notably improved processes and quality and controlling healthcare costs — there’s a catch.  He suggests that funds from HITECH which pay for the incentives, $10 billion of which still haven’t been disbursed, are a tempting target for budget shrinkers, possibly under the mantle of clawing back stimulus funding.

Lundstrom’s on to something there. Given that the stimulus was not a bipartisan project, it does seem to me that health IT fans may finally have something to worry about. That’s especially true given the letter four congressmen wrote to HHS in September arguing for a halt in Meaningful Use disbursements until better interoperability was achieved.

I’m not a political junkie and have no access to Capitol Hill chatter on this subject. But as a supporter of Meaningful Use payouts generally — if not every detail of their execution — I’m troubled by Lundstrom’s analysis, as I do think the lack of progress on  interoperability to date gives MU foes a toehold.

Cutbacks on EMR incentives would probably do little to stop the automation of hospitals.  But I think it’s fairly clear that market momentum would not push the reluctant small group practices which are still health IT challenged to pick up costly, confusing, hard to use EMRs without some reward for their efforts.  It’s that sector we should be worrying about if the budget cutters’ eye turns to that $10 million incentive reserve.

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March 15, 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.

Filed Under: EMR Financing  HITECH  Hospital EHR  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Hospital IT Systems  Meaningful Use
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HIMSS: Hospitals Achieving Meaningful Use Milestones

Hospitals are making good progress toward achieving Meaningful Use milestones, a new study by HIMSS suggests.

HIMSS, which surveyed 298 healthcare CIOs between December and February, found that 66 percent had already qualified for Meaningful Use stage 1, while another 4 percent expected to do so before the end of 2012, Information Week reports.

Meanwhile, 75 percent of respondents said they expect to attest for stage 2 in 2014, which  as readers probably know is the first year of stage two attestations.

Given the ambitions noted by the CIOs, it’s not surprising to learn that 66 percent of them said they thought their budgets would definitely or probably increase this year.  Of the remainder, 15 percent said their budgets would remain level, and 8 percent expected to see a decrease.

Last year, achieving Meaningful Use was the hospital CIOs’ top business objective, named by 24 percent of respondents, but this year, it fell to 15 percent. This year, the top health IT business objective has switched over to survival, with 21 percent saying their key goal was to sustain the financial viability of their organizations.  This was followed closely by improving patient care, which came in at 19 percent.

Still, Meaningful  Use will obviously stay top of mind for the CIOs, who may be better prepared than last year but still have much to handle.

After all, they expect to make serious money on achieving MU goals, HIMSS concluded. The survey found that about 30 percent of hospital CIOs expected an ROI of up to $2 million on stage 1, another 23 percent a return of $2 million to $3 million, and 16 percent expected ROI of $4 million to $5 million.

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March 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.

Filed Under: EMR ROI  Healthcare CIO  Hospital CIO  Hospital EHR  Hospital EHR Conferences  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital Healthcare IT  Hospital IT Budget  Meaningful Use
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ACOs Need Population Health Help From EMRs

It’s hard to argue that without an EMR, Accountable Care Organizations would be somewhat adrift. After all, any structure that demands a high level of coordination between multiple organizations benefits from a shared EMR backbone.

But do EMRs do a good job of managing population health, the other key responsibility of ACO clinicians?  Let’s take a look at the criteria suggested by David Nash, MD, MBA, who’s Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University. Dr. Nash notes that primary care physicians in an ACO need the following:

  • A registry to monitor and evaluate my patients – not just individually but as a population
  • Relevant data on my patients who share a specific diagnosis such as hypertension or asthma
  • Information on how my medical management and patient outcomes compare with other local practices
  • Information on where my practice stands in comparison with national benchmarks

Let’s see.  Do leading EMRS offer a registry to monitor patients as a group?  Automatically serve up data on patients who share a specific diagnosis?  Offer means of benchmarking outcomes with other local practices or national standards? No, no and no.

I can hear EMR vendors out there saying, “Hey, wait a minute. That stuff is not our problem!”  And historically, they’d probably be right.  After all, it’s a formidable enough job creating usable, flexible, reliable medical record analogues in digital form.

The truth is, however, that population health measures are central to the medical home, ACOs and the future of medicine generally.

My guess is that for the next few years, hospitals and large medical practices — even those who have launched an ACO — will be preoccupied enough with meeting Meaningful Use  measures that they won’t be demanding more extensive population measures soon.

Still, enterprise EMR vendors will need to offer tools that meet broad population health goals eventually, as the large organizations that buy their products will soon be demanding these types of functions.  The only question is when.

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February 13, 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.

Filed Under: Hospital EHR  Hospital EHR Vendor  Hospital Electronic Health Record  Hospital Electronic Medical Record  Hospital EMR  Hospital EMR Company  Hospital EMR Vendor  Hospital Healthcare IT  Meaningful Use
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