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Data Sharing Largely Isn’t Informing Hospital Clinical Decisions

Posted on July 6, 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.

Some new data released by ONC suggests that while healthcare data is being shared far more frequently between hospitals than in the past, few hospital clinicians use such data regularly as part of providing patient care.

The ONC report, which is based on a supplement to the 2015 edition of an annual survey by the American Hospital Association, concluded that 96% of hospitals had an EHR in place which was federally tested and certified for the Meaningful Use program. That’s an enormous leap from 2009, the year federal economic stimulus law creating the program was signed, when only 12.2% of hospitals had even a basic EHR in place.

Also, hospitals have improved dramatically in their ability to share data with other facilities outside their system, according to an AHA article from February. While just 22% of hospitals shared data with peer facilities in 2011, that number had shot up to 57% in 2014. Also, the share of hospitals exchanging data with ambulatory care providers outside the system climbed from 37% to 60% during the same period.

On the other hand, hospitals are not meeting federal goals for data use, particularly the use of data not created within their institution. While 82% of hospitals shared lab results, radiology reports, clinical care summaries or medication lists with hospitals or ambulatory care centers outside of their orbit — up from 45% in 2009 — the date isn’t having as much of an impact as it could.

Only 18% of those surveyed by the AHA said that hospital clinicians often used patient information gathered electronically from outside sources. Another 35% reported that clinicians used such information “sometimes,” 20% used it “rarely” and 16% “never” used such data. (The remaining 11% said that they didn’t know how such data was used.)

So what’s holding hospital clinicians back? More than half of AHA respondents (53%) said that the biggest barrier to using interoperable data integrating that data into physician routines. They noted that since shared information usually wasn’t available to clinicians in their EHRs, they had to go out of the regular workflows to review the data.

Another major barrier, cited by 45% of survey respondents, was difficulty integrating exchange information into their EHR. According to the AHA survey, only 4 in 10 hospitals had the ability to integrate data into their EHRs without manual data entry.

Other problems with clinician use of shared data concluded that information was not always available when needed (40%), that it wasn’t presented in a useful format (29%) and that clinicians did not trust the accuracy of the information (11%). Also, 31% of survey respondents said that many recipients of care summaries felt that the data itself was not useful, up from 26% in 2014.

What’s more, some technical problems in sharing data between EHRs seem to have gotten slightly worse between the 2014 and 2015 surveys. For example, 24% of respondents the 2014 survey said that matching or identifying patients was a concern in data exchange. That number jumped to 33% in the 2015 results.

By the way, you might want to check out this related chart, which suggests that paper-based data exchange remains wildly popular. Given the challenges that still exist in sharing such data digitally, I guess we shouldn’t be surprised.

Healthcare Tradition and Healthcare Innovation

Posted on July 5, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare Innovation and Tradition

I think we have to be careful taking this comment too far. Many healthcare traditions are good. We shouldn’t throw out all healthcare traditions. However, we should question many of our healthcare traditions to see, Who’s right, who’s wrong, and how might things have changed?

I’ve heard and seen far too many stories of doctors and other healthcare professionals that aren’t interested in listening to anything that would require them to change. I believe it’s the minority of providers, but it’s a stubborn minority that’s causing much of healthcare not to progress. The largest group is likely those that are willing to change but don’t take the time to explore change (I don’t blame them for not exploring more considering the treadmill we’ve stuck them on). They do what they’ve “always” done because they don’t know any better. There’s safety in doing what you’ve “always” done.

All of that said, Andy is right that innovation lives in the midst of change and discomfort.

Nominate Someone to the #HIT100

Posted on July 4, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As has become a July 4th tradition, the healthcare IT social media community comes together to recognize the incredible people on healthcare social media that influence their lives. It’s called the #HIT100 and happens on Twitter with people nominating the people that influence them for good. It’s really simple to participate and a great way to show some gratitude and love for someone you appreciate. Here are the details from the official announcement:

Required hashtags:

(Each nomination should have all of these)

  • #HIT100 or #HIT99 (One or the other is required)
  • #HealthIT (Optional)
  • #HITsm (Optional)

Optional hashtags:

(Please use only one of them so that the analytics have value)

  • #FHIR (Optional)
  • #Interoperability (Optional)
  • #PersonalizedMedicine or #PrecisionMedicine (Optional)
  • #Genomics

Some rules will change this year due to the analytical tools being put in place for the first time:

NOMINATION RULES:

  1. Nominations start
    Friday July 1st 2016 at 6PM and end on Friday July 8th at 6PM
  2. Only one person at a time may be nominated.  Multi-nominations in one tweet will not be counted though they might form part of the analytical information base
  3. Only direct nominations will be counted.  Retweets will not be counted though they may be analyzed for further enjoyment
  4. Favorites will not be counted though they may be analyzed for further entertainment
  5. There will only be one cycle of nominations.  No delegates or super-delegates here
  6. I reserve the judgement to disqualify a nomination that I find suspicious for any reason
  7. You are encouraged to include one of the optional hashtags above so that we can process with analytics to get some statistics about each one of them
  8. You can add a sentiment to the end of the nomination
  9. You must have fun and please follow each other as you discover new members of our community

If that’s too confusing, here are a couple examples. You can copy and then edit as appropriate.

I nominate @ehrandhit to the #HIT100 list – #HealthIT #HITsm #FHIR – Because they curate amazing content!

I nominate @techguy to the #HIT100 list – #HealthIT #HITsm He offers great insights into #PrecisionMedicine

Join in the fun and recognize your favorite people on social media! Happy 4th of July!

The Rise of the “EHR Value” Equation at Hospitals

Posted on July 1, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve heard a lot of people talk about how it will be impossible for ambulatory EHR vendors like athenahealth and eCW to break into the acute care market. For those following along at home, both companies have announced that they’re building out their EHR software for the acute care market. These are big bets by both companies, but I think many people don’t realize the advantage these companies will have going into the very expensive hospital EHR market.

Companies like eCW and athenahealth will be able to come into a hospital with a native cloud platform that will let them offer some really aggressive pricing. When you’re paying $50+ million for an EHR (or $9+ billion for some), there’s a lot of wiggle room for a new entrant to enter the fray at a much lower cost point. That lower cost point will totally change the EHR value equation for hospitals. In fact, these cloud based hospital EHR will likely be able to compete effectively against a legacy EHRs upgrade costs alone.

Don’t believe this is possible? Take a look at the story about Delta Regional Hospital returning to MEDITECH. Why did they do it? Thomas Moore, vice president and CFO at Delta said, “We were looking for a system with a lower cost of ownership without sacrificing quality.” Moore later added this comment, “MEDITECH is a company that truly understands the meaning of value.”

During the wild west phase of EHR where the industry was propped up by $36 billion in stimulus money, everyone had the perfect rationale for spending hundreds of millions (and even billions) on EHR software. As we return to a more rational market we’re going to see hospital CIOs starting to place a much larger emphasis on EHR value. Showing that value is going to be hard for some of the larger EHR vendors who’ve charged hundreds of millions and even billions of dollars to their customers. Plus, it will be hard for them to lower their price.

In one online thread I participate on, a bunch of people were bashing Delta Regional Hospital’s decision to go back to MEDITECH. However, a former CIO offered this great insight:

Ya gotta spend time in a Meditech shop. It’s not flashy, but from a value perspective (and it does a lot more than just EHR), it’s hard to beat.

The same is going to be true with acute care EHR from eCW and athenahealth, but they’ll have some of the sexy factor as well. In the acute care EHR world I believe we’re just entering the new world of EHR value. Those who can tell the story of the value they’ve created for customers are going to win. Plus, we’re going to see a fierce battle from new entrants who are going to try and undercut the market. Think about how the EHR value equation changes when you can charge even $75 million instead of $100 million. That’s a game changer.

Hospital Accused Of Firing Nurse For EMR Safety Complaints

Posted on June 29, 2016 I Written By

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

The former chief nursing officer of a California hospital is suing her former employer, alleging she was “forced out” of her position after questioning the safety of a little-known EMR donated by a major financial backer of the facility.

The suit filed by nurse Autumn AndRa also names Dan Smith, whose company donated the Harmoni software now used by Sebastopol, CA-based Sonoma West Medical Center. AndRa is claiming that Smith, who has contributed millions in donations and loans to the hospital, has used the hospital as a test bed for his company’s defective system. Smith is president of the medical center’s board of directors.

In an interview with a local newspaper, AndRa said that the Harmoni system has had major problems since the day it went live. Among other issues, the EMR was doing a poor job tracking and updating medications and was “intermingling” medical information between patients, her suit contends. According to AndRa, she went to hospital CEO Ray Hino a week before her dismissal and told him that the system was not safe. (Hino told the newspaper that Harmoni was fine and that no patients had been harmed by the system.)

E-Health Records International Inc., which makes the cloud-based system, primarily serves hospitals outside the U.S., including facilities in the Congo, Jamaica, India and the Philippines. Smith, whose first software development success came when he sold a construction management system to Intuit, serves as the company’s CEO, as well as chairman of telemedicine firm Offsite Care Resources.

Other than that, he seems to have little documented experience as an HIT developer. His other major business venture seems to have been operating a French restaurant with his wife, which he closed after being unable to get back $5.8 million he loaned the hospital.

Regardless of whether AndRa prevails in her suit, I think it’s safe to say that she came out on the wrong end of some questionable political maneuvering by hospital leaders, perhaps including Smith himself. When a hospital is forgiven a large loan, and then fires an executive who raises safety questions about the EMR developed by the lender, eyebrows should be raised.

A Humorous Look at Healthcare as #HFMA2016ANI Begins

Posted on June 27, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As part of RelayHealth’s (Part of McKesson) announcement during ANI 2016, they put out some cartoons that look at some of the challenges that continue to plague healthcare. I’m sure they’ll be posting a bunch of them on Twitter @McKesson_MHS and @RelayHealth, but these two really gave me a good laugh.

Healthcare Sticky Notes Cartoon

Don’t underestimate the power of sticky notes!

Healthcare Claims Cleanup Cartoon

Looks like it’s going to be another banner year for HFMA’s ANI conference. It’s a unique venue where so much money is flowing since there’s so much financial waste in healthcare. Don’t believe me? I saw one company advertise that they were giving away a Harley Davidson or $15,000. Chew on the ROI of that investment. Says a lot about the type of deals that are signed at ANI.

Operationalizing Health IT Discoveries

Posted on June 24, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been talking a lot lately with people about how we take the health IT discoveries made at one hospital and apply them to another hospital. In a recent conversation I had with Jonathan Sheldon from Oracle, he highlighted that “Many organizations don’t care about research, but just want a product that works.”

I agree completely with this comment from Jonathan. While there are some very large healthcare organizations that do a lot of research, there are even more healthcare organizations that just want to see patients in the best way possible. They just want to implement the research that other organizations have done. They just want something that works.

The problem for big companies like Oracle, SAP, Tableau, etc is that they have the technology to scale up many of these health IT discoveries, but they aren’t doing the discovery themselves. In fact, most of them never will dive into the discovery of which healthcare data really matters.

In order to solve this, I’ve seen all of these organizations working on some sort of partnership between IT companies and healthcare research organizations. The IT company provides the technology and the commercialization of the product and the healthcare research organization provides the research knowledge on the most effective techniques.

While this all sounds very simple and logical, it’s actually much harder in practice. Taking your customer and turning them into a partner is much harder than it looks. Most healthcare organizations know how to be customers. It takes a unique healthcare organization to be an effective partner. However, this is exactly what we have to do if we want to operationalize the health IT discoveries these research organizations make.

We’re going to have to make this a reality. There’s no way that one organization can discover everything they need to discover. Healthcare is too complex as it is today. Plus, we’re just getting started with things like genomic medicine and health sensors which is going to make healthcare at least an order of magnitude more complex.

Population Health Tech Will Lag Until Standards Emerge

Posted on June 22, 2016 I Written By

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

There’s little doubt that healthcare organizations will continue to partner up with peers and acquire physician practices. The forces that drive healthcare network development are only intensifying as time goes by, particularly as the drive toward value-based payment moves ahead. But there’s a lot more to making such deals work than a handshake and a check. To make these deals work, it’s critical that networks become experts at population health management — and unfortunately, that’s going to be tough.

While merging health systems into ACOs or acquiring referring physicians has merit, this strategy won’t grow the steadily dropping pace of hospital admissions, notes William Faber, M.D., senior vice president of the GE Healthcare Camden Group. “Though clinically integrated networks do enlarge the patient base, one of their aims is also to reduce the percentage of admissions from that base,” making it unlikely that the networks will grow admissions, he points out.

To make a clinically integrated network successful, it certainly helps to take the initiative – to get to market more quickly than competitors – and to do a better job of controlling costs of care and demonstrating higher quality and service. Where things get stickier, however, is in managing that care across a large group. “The creation of a clinically integrated network must not be just a marketing or physician alignment strategy – it must truly enable effective population health management,” he writes.

And this, I’d argue, is where things get very tricky. Well, judge for yourself, but I’d argue that the HIT industry is ill-equipped to support these goals. Despite many years of paper-chart experimentation with population health, and several with population health technology, my sense is that the tech is far behind what it needs to be. Health IT vendors won’t get far until providers do a better job of defining what they need.

A different mindset

The truth is, this generation of EMRs is designed to track individual patients across an experience of care. While CIOs can add a layer of analytics technology to the mix, that is a far cry from creating tools that natively track population health trends. Looking at populations is simply a different mindset.

Admittedly, vendors will tell you that they’ve got the problem licked, but if they were completely candid many would have to admit that their products aren’t mature yet. Until someone creates an EMR or other basic tool which is designed, at its core, to track group health trends, I foresee more half-baked hacks than results.

What’s more, I doubt the health IT business will be able to help until it has at least an informal standard to which such products must adhere. Should such tools measure costs of care by diagnosis code? Compare such costs to national standards? Highlight patients in outpatient settings whose tests or exams suggest a crisis is about to happen? If so, which settings, and what cutoffs should be tracked for test scores? Does such a system need natural language processing to scour physician notes for trigger words, and if so which ones?

Without a doubt, medical and business executives leading integrated networks will come together and develop more answers to these questions. But until they do, health IT vendors won’t be able to help much with the population health challenge.

Methods of Data Exchange in Healthcare

Posted on June 20, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Jane Sarasohn-Kahn has a great chart on her Health Populi blog which shows how healthcare shares health data:
Healthcare Data Sharing Methods and Options

The chart is great even if the results are pretty awful. Plus, the data is a little dated. I wonder how those numbers have changed since early 2015.

Amazing that the top 3 forms of data exchange in healthcare were old analogue technologies: paper, information (phone), and fax.

This will come as no surprise to anyone in healthcare. I do find it interesting that the 4th most popular method is scanning the documents directly to the provider. That illustrates that most clinics would love to have an electronic option for sharing data, but there’s not an easier way. The options that are currently available are too hard. If they were easier, then I believe almost every practice would adopt them.

With all the benefits of direct exchanges, HIE, portals, Direct, FHIR, etc, it’s amazing that a simple document scan sent directly to a clinic is more popular. It makes me take a step back and wonder if we’ve over complicated the process of health data exchange.

Would the best option be to step back and make exchange much easier? Could we strip out all the extra features that are nice but impede participation from so many?

I can’t wait for the day that my health data is available wherever it’s needed. The first step to that reality might be taking a step back and simplifying the exchange of data.

Hospitals’ Progress Towards Value Based Reimbursement

Posted on June 17, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After posting the value based reimbursement research results that were shared by McKesson Health Solutions in anticipation of the AHIP Institute, I came across this infographic from Health Catalyst about hospitals participation in value based reimbursement.

This infographic illustrates a slower adoption of value based reimbursement, but it does illustrate that pretty much every hospital is participating in value based reimbursement. The other thing that stood out to me in this infographic was how small hospitals are going to have a hard time accessing the capital they need to manage this shift. This should be troubling to those of us in healthcare. Those smaller hospitals play an important role in our healthcare system.

Hospitals Progress to Value Based Reimbursement