Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

UPMC Kicks Off Mobility Program

If you’re going to look at how physicians use health IT in hospitals, it doesn’t hurt to go to doctors at the University of Pittsburgh Medical Center, a $10 billion collosus with a history of HIT innovation. UPMC spans 21 hospitals and employs more than 3,500 physicians, and it’s smack in the middle of a mobile rollout.

Recently, Intel Health & Life Sciences blogger Ben Wilson reached to three UPMC doctors responsible for substantial health IT work, including Dr. Rasu Shrestha, Vice President of Medical Information for all of UPMC, Dr. Oscar Marroquin, a cardiologist responsible for clinical analytics and new care model initiatives, and Dr. Shivdev Rao, an academic cardiologist.

We don’t have space to recap all of the stuff Wilson captured in his interview, but here’s a few ideas worth taking away from the doctors’ responses:

Healthcare organizations are “data rich and information poor”: UPMC, for its part, has 5.4 petabytes of data on hand, and that store of data is doubling every 18 months. According to Dr. Shrestha, hospitals must find ways to find patterns and condense data in a useful, intelligent, actionable manner, such as figuring out whether there are specific times you must alert clinicians, and determine whether there are specific sensors tracking to specific types of metrics that are important from a HIM perspective.

Mobility has had a positive impact on patient care:  These doctors are enthusiastic about the benefits of mobility.  Dr. Marroquin notes that not only do mobile devices put patient care information at his finger tips and allow for intelligent solutions, it also allows him to share information with patients, making it easier to explain why he’s doing a give test or treatment.

BYOD can work if sensitive information is protected:  UPMC has been supporting varied mobile devices that physicians bring into its facilities, but has struggled with security and access. Dr. Shrestha notes that he and his colleagues have been very careful to evaluate all of the devices and different operating systems, making sure data doesn’t reside on a mobile device without some form of security.

On the self-promotion front, Wilson asks the doctors about a pilot  project (an Intel and Microsoft effort dubbed Convergence) in which clinicians use Surface tablets powered by Windows 8. Given that this is an Intel blog, you won’t be surprised to read that Dr. Shrestha is quite happy with the Surface tablet, particularly the form factor which allows doctors to flip the screen over and actually show patients trends.

Regardless, it’s interesting to hear from doctors who are gradually changing how they practice due to mobile tech. Clearly, UPMC has solved neither its big data problems nor phone/tablet security issues completely, but it seems that its management is deeply engaged in addressing these issues.

Meanwhile, it will be interesting to see how far Convergence gets. Right now, Convergence just involves giving heart doctors at UPMC’s Presbyterian Hospital a couple dozen Microsoft Surface Pro 3 tablets, but HIT leaders plan to eventually roll out 2,000 of the tablets.

July 1, 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.

Sutter Health Ready To Deploy HIE, But Can It Succeed?

Sutter Health doesn’t have a great reputation when it comes to EMR implementation. Late last year, when we reported that Sutter’s Epic EMR crashed for an entire day, comments came pouring in about the company’s questionable approach to training its staff on using the system.

According to Epic consultants who’d been involved in the project, Sutter leaders decided that Epic experts were there to “facilitate” training done by inexperienced in-house teams, rather than actually teach key users what they need to know. The result was strife, disorder and anxiety, according to several consultants who’d been involved. Since then, Sutter has connected its EMR to five medical foundations and 17 hospital campuses; by next year, it expects the EMR to connect to information on 3 million patients. But there’s no reason to think it’s changed its training strategy, which could cast a bit of a pall over the new project.

Now, Sutter Health is building out a health information exchange, working with Orion Health, which will tie together hospitals and doctors both inside and outside of its network across northern California. Sutter plans to begin deploying the HIE in phases this summer, starting with data integration with the Epic EMR and extending to testing exchange of inbound and outbound data. If the project works out, it seems likely that it will be a plus for every provider that does business with Sutter.

The question is, will Sutter do a better job of managing this process than it did in rolling out its EMR? While it’s easy to boast that your plans are going to be a “gamechanger” for the market, it’s hard to take that claim at face value when your EMR implementation hasn’t gone so splendidly.

Certainly, Orion is a reputable HIE vendor which has been praised for having strong products and service. And Sutter certainly has the financial wherewithal to see such an effort through. The thing is, if Sutter leaders (seemingly) took a wrongheaded approach to the all-important issue of EMR training, who knows what curveballs they might throw into the process of rolling out an HIE? Even if its EMR has stabilized and Sutter has somehow gotten past its training hurdles, its past missteps don’t inspire confidence.

If I were with Orion, I’d draw a firm line where training was concerned, as Sutter’s past strategy only seems to have cast its last major HIT vendor in a bad light. If not, I’d make sure the contract had a workable bailout clause…or be prepared for some serious headaches.

June 30, 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.

Drop in ED Visits Post-Obamacare?

Dan Munro posted an interesting chart from Gallup that shows the percentage of uninsured in the US since 2008:
Uninsured Americans Since 2008 - Gallup
The chart clearly shows a drop in those that are uninsured. I think we can quite confidently say that this is the result of Obamacare where many uninsured Americans could get free health insurance. While many are proclaiming this data illustrates that this means that Obamacare is a success, I think the jury is still out.

In fact, this reminds me of those who consider the EHR incentive money and meaningful use a success because EHR adoption has increased. This might be true, but it might also be true that the wrong EHRs were adopted and so we wasted a lot of money encouraging the adoption of the wrong EHR. That’s just one example. It’s good that there’s been a change, but change does not always mean that we changed for the better.

Going back to the rise of the insured population in the US, I wonder if those newly insured have stopped going to the ED. That was one of the arguments that were made by proponents of ACA. Basically, the uninsured knew they could go to the ED anytime they wanted and not be turned away. Now that many of those people have health insurance, are they now going to a doctor’s office instead of the ED?

I haven’t seen any numbers that indicate this is the case. Plus, I fear that those who do switch from the ED to the doctors office will learn about deductibles and head right back to the ED.

If you have data on this trend, I’d love to see it. No doubt how this goes will have a tremendous impact on the bottom line of hospitals.

June 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

The Connection of Sports and Healthcare

It seems like the soccer tide has hit the US as more and more as ESPN finally decided to broadcast the entire World Cup. The viewer numbers have been great. I expect many in healthcare will be tied to their computers or a TV in their hospital watching the US play Germany today. While not totally universal, it’s amazing the way sports can bring people together.

I was reminded of this when I saw this tweet from Mass General Hospital in Boston:

I’m a Dolphins fan, but understand why many would love to see Gronk and other Patriot players at their hospital. Pretty cool. Plus, so many hospitals are non-profits, so I guess this is considered charity work for the players. No doubt sports can be a great way for a team to bond together.

Of course, what does this have to do with healthcare IT? Nothing really. Unless you’re the IT director at a hospital that’s watching your bandwidth consumption during the 2 hours of the World Cup go through the roof. That would be interesting to see.

I guess it’s fair to say I have a bit of World Cup fever as well.

June 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

A Hospital CFO Perspective on EHR Expense

The past couple days I’ve been able to enjoy a couple days sitting down with hospital CFO’s at HFMA’s ANI conference in Las Vegas. I think this is the third time I’ve attended the event and it’s always a really interesting conference since hospital CFOs have a great financial perspective into the running of a hospital.

While at the big dinner celebration they had last night at the event, I asked a hospital CFO what she thought of the event and what she’d learned. She responded:

The sessions really helped me feel good about the small investments we’ve been making in population health and analytics. I think were going in the right direction.

Then she added this after thought that was telling:

Not to mention justifying the insane amount of money we’re spending on our EHR.

I think we’ve done a really poor job of explaining why the EHR is worth the investment. Let’s be honest though. Most of the EHR implementations haven’t been about leveraging the EHR to improve the organization. They’ve been focused on the meaningful use regulatory requirements, getting the EHR incentive money, and avoiding the EHR penalties.

Going forward we’re going to have to shift our thinking. We’re going to have to do a much better job justifying the EHR expense by showing the benefits an EHR provides a hospital organization.

June 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

AHA urges agencies to speed up EMR choice expansion

In a move that shouldn’t surprise anybody, the American Hospital Association is urging CMS and the ONC to hurry up and finalize new rules which would expand choice for certified EMRs.

The AHA letter argues that its members are on the verge of walking away from Meaningful Use. But if CMS and the ONC speed ahead with with the new proposed rules — which would offer more choice in specific meaningful use requirements they must meet this year — hospitals will be much better equipped to proceed.

Why the rush? Well, for one thing, the letter argues, time is of the essence for hospitals, which have to decide their meaningful use strategy for fiscal 2014. If they must make choices before the new rule is finalized, it could cause them “significant financial and operational harm,” the AHA contends.

Meanwhile, if the agencies don’t push these rules through quickly, “many providers are likely to conclude that they cannot meet meaningful use this year and abandon the program,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development, in a letter to CMS Administrator Marilyn Tavenner and National Coordinator Karen DeSalvo, MD.

The letter also takes on other issues. It asks that CMS and ONC clarify the rules implementation, offer more flexibility in the reporting of clinical quality measures, shorten the MU reporting period for 2015 in analyze lessons learned from Stage 2 before finalizing Stage 3′s start date, according to HealthcareITNews.

The AHA’s letter comes at a challenging time for the meaningful use program generally, which has of late attracted broader attention than it has in the past.

Not only are industry groups pressuring ONC, legislators are too. For example, at a recent health IT conference, U.S. Rep Tom Price, MD, R-GA, argued that meaningful use is “maybe not even doing what needs to be done as it relates to patients and physicians.”

In his remarks, Price argued that meaningful use could be improved by keeping the patient front and center, making sure patients know they own their health data and establishing an interoperability standard.  But he suggests that because the MU program roadmap was laid out in the HITECH Act, it’s not as fluid as it should be and doesn’t accommodate such concerns.

The reality, however, is that there is no simple way to get interoperability; right now, we’re lucky if individual EMRs meet providers’ needs.  Despite the demands from other stakeholders, health IT vendors still have a lot more to gain by creating islands rather than interoperable products.

June 23, 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.

CDS Technology: A Value Proposition for MU

The following is a guest blog post by Bonnie Briggs, Director of Product Management for Wolters Kluwer Health.

As the industry turns towards Stage 2 Meaningful Use (MU) attestation with greater urgency and anticipates the forthcoming criteria for Stage 3 and beyond, healthcare providers are increasingly looking for effective ways to streamline compliance and best position for the future. With so many initiatives competing for limited dollars, the value proposition of any health IT investment is critical to meeting current and future regulatory objectives—and qualifying for attractive incentive payments that can deliver a whopping $7 million to the average 200-bed hospital for Stage 2 alone (based on the current Medicare share and transition factor).

As MU moves past the Stage 1 focus of basic data capture within an EHR, healthcare organizations need to lay a foundation to address the more advanced clinical processes and improved outcomes focus of Stages 2 and 3. Use of clinical decision support (CDS) technology at the point of care is a focal point of compliance as it sets the stage for greater adoption of evidenced-based practices to improve outcomes.

While drug reference and drug interaction data applications are obvious choices for meeting Stage 2 MU CDS requirements for drug-drug, drug-allergy and drug-disease interactions screenings, healthcare organizations need to consider that not all solutions are advanced enough to address other key MU requirements, namely patient education/engagement requirements and HL7 Infobutton capability. Specifically, the industry’s most advanced products can help fill in the gaps by providing appropriate tools for educating and engaging patients and linking clinicians to the most relevant content.

Addressing Patient Education and Limited Health Literacy

Industry research reveals that there is a considerable disconnect between the language of clinicians and the ability of patients to comprehend the relevance and importance of what is being communicated. In fact, nearly half of American adults have some level of limited health literacy when it comes to using and understanding written health information alone, according to the Institute of Medicine (IOM).

One area that has become a focal point of regulatory discussion related to patient education and health literacy is the need to accommodate non-English-speaking patients. The National Standards on Culturally and Linguistically Appropriate Services (CLAS) states that “health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service areas.”

While Stage 2 MU requirements call for the use of EHRs to identify patient-specific education resources, Stage 3 recommendations released by the HITPC Meaningful Use Workgroup earlier this year point to the potential of this rule being expanded to support language needs. Specifically, the recommendation calls for the “use of CEHRT capability to provide patient-specific educational material in non-English speaking patients’ preferred language.”

When considering the value proposition behind the use of CDS technology in the form of drug reference applications, the availability of consumer-level content that addresses a broad array of foreign languages should be considered to best position for compliance going forward. Industry recommendations also suggest that materials be written on a 5th to 7th grade level, using simple sentence structures and short, bulleted statements for easy reading. Other key considerations for effectively engaging patients include age-appropriate illustrations and the provision of materials in larger fonts for the visually impaired.

The Infobutton Challenge

Compliance with MU patient education standards also means that certified EHRs must support the Health Level 7 International Context-Aware Knowledge Retrieval standard, more commonly referred to as the HL7 Infobutton. This industry standard must be used to access patient-specific education materials based on relevance. It may also provide links to referential CDS as an option.

A widely accepted and adopted standard, the Infobutton essentially enables EHRs to generate a view of a patient encounter based on standard patient and provider information. From that information, an EHR application can gather appropriate patient education materials based on the specific details of that case at the click of a button.

The challenge for healthcare organizations will be identifying CDS applications that are equipped to gather patient data in this way. When advanced drug reference applications can aggregate this information from problem lists, medication lists and laboratory results and support Infobutton contextual parameters for identifying appropriate knowledge resources, the value proposition as it pertains to MU compliance is heightened.

Conclusion

When positioning for effective use of CDS at the point of care to meet current and future MU objectives, healthcare organizations need to be careful of making knee-jerk decisions and consider the best technological foundations for long-term success.

While a number of CDS applications on the market can address the basics of drug-drug, drug-allergy and drug-disease interactions screenings, not all are equipped for the broader patient education focus currently unfolding. Considerations should be made for addressing the bigger picture of health literacy and evolving industry standards such as HL7 Infobutton capability.

Bonnie Briggs, RPh, MBA, is the Director of Product Management for Wolters Kluwer Health. She can be reached at bonnie.briggs@wolterskluwer.com.

June 19, 2014 I Written By

Georgia EMR Disaster: Was IT Department Responsible?

A few weeks ago, heads began to roll at Georgia’s Athens Regional Health System when its $31 million Cerner rollout began to fall apart. After clinicians complained that a rushed rollout process was generating a host of medication errors and other mistakes, President and CEO James Thaw resigned, and less than a week later, SVP and CIO Gretchen Tegethoff left as well.

Since then, however, the political landscape there has changed, with the facility’s chief medical officer, as well as Cerner executives, contending that the disaster was due to mistakes by the health systems IT team, according to HealthcareITNews. The Cerner execs, CMO and others are arguing that IT leaders made strategic decisions that should’ve been made by clinicians, the publication says.

A local paper, the Athens Banner Herald, notes that the Cerner rollout was done largely by the hospital’s IT team, and that few end-users were involved. That, at least, is what Cerner VP Michael Robin told the paper.  And a different Cerner VP, Ben Himes, took another shot at the IT department, arguing that this implementation seems to have come out on the IT side of things, rather than stressing clinical involvement.

The bottom line seems to be that regardless of what actually happened, the clinicians at the hospital seem to of felt left out of the process, never good thing when we’re dealing with a tool that they’ll need to use everyday.  Regardless of what actually happened, it seems the hospital’s IT department didn’t do a good job of engaging clinicians and getting their feedback; under those circumstances, the likelihood of kicked up a fuss even if implementation was otherwise smooth.

On the other hand, I’m always a little skeptical when vendors point fingers at their customers and say it was their fault when things go wrong. OK, I realize that there may be some truth to their accusations, and that Cerner has a right to defend itself, but it’s hardly a good PR move to dump problems with the implementation completely in the customer’s lap.

The truth is, will probably never know exactly what happened with this EMR implementation. Considering the scale of the project, and the number of people involved, it’s inevitable that this will go down in a blaze of finger-pointing. But it never hurts to be reminded that EMR implementations which leads physicians feeling as though they’re on the sidelines are politically risky at best, and potentially disastrous at worst.

 

June 18, 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.

Epic’s 13 Principles

I recently came across this blog called “Life After Epic” which has the subtitle, “For the soon-to-be-Ex Epic Employee.” Although, if you look at the blog address it’s FiredFromEpic.blogspot.com. I assume Fired from Epic was the original blog name, but was likely changed for obvious reasons.

I’m sure I’ll reference more articles from this blog in the future, but I was really intrigued by the 13 Epic Principles that the blog’s been covering recently. Epic’s 13 Principles definitely provide some interesting insight into the EHR vendor Epic.

1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don’t do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don’t take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

What do you think of these principles? If you’ve dealt with Epic, you’ve no doubt seen a lot of them in action.

June 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Pennsylvania Hospital Sees Data Breach

No matter how careful you are with patient data, there’s always a way for it to slip out the door or be accessed illegitimately. That’s why a Pennsylvania-based hospital has been forced this to notify almost 2,000 patients that an employee had committed a HIPAA breach.

The 551-bed Penn State Milton S. Hershey hospital learned, after conducting an internal investigation, that an employee accessed and transmitted protected health data outside of the hospital’s secure information network. The hospital was forced to inform 1,801 patients that their names, medical record numbers, lab tests and results and visit dates could conceivably have been accessed by unauthorized persons or entities due to an employee mistake.

The HIPAA breach was due to a mistake by a Penn State Hershey clinical laboratory technician, who was authorized to work with PHI but did so insecurely. The lab tech accessed patient data via an insecure USB devices through his home network rather than the hospital network, as well as sending patient data via his personal email address to two hospital physicians.

To date, Penn State Hershey has had a respectable track record for security. As HealthcareITNews notes, this is the first large HIPAA breach the facility has reported to HHS.

But there’s clearly an education gap here if an otherwise well-behaved lab tech didn’t know that he be compromising data if he accessed and sent it this way.

To prevent breaches like this from becoming common, hospitals need to keep up an ongoing education program which continually re-emphasizes the dangers of outside-network communication, unencrypted communications, data storage on easily stolen laptops and phones and more. But few hospitals offer the level of education required to fend off everyday accidents like this one.

But education isn’t the only security challenge facing hospital IT departments. There’s also an issue that remains in hospital security which, as we discuss HIPAA breaches, is worth a quick note. While it’s critical to educate staffers  on what they can do to avoid HIPAA breaches, health IT departments themselves may need a refresher from time to time,  notes my colleague John Lynn.

John notes that while hospital IT staffers may have strong antivirus software protecting their facility, their malware protections are often weak, as software that locks staff computers down too much often makes users angry.

As he sees it, the next wave of security breaches may not be due to human error (or malicious content) but unseen malware quietly feeding data to health data thieves. Not only that, he expects to see personal mobile phones get compromised and infect the hospital network. All scary stuff.

June 16, 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.