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Healthcare IT Jobs – The Move from Consultant to FTE

Posted on June 19, 2015 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.

In hospital IT we’re seeing a lot of changes happening with how a hospital IT department staffs itself. The past couple years, most hospitals have been busy implementing their EHR. This required them to hire a lot of EHR consulting companies that could scale up their manpower requirements for the implementation. In fact, many of these so called EHR consulting companies were actually just staff augmentation companies dressed as consultants. I even noted that the Healthcare IT Industry was addicted to consultants.

I think over the last 6 or so months, we’ve seen a move away from hiring as many consultants (we still love a good consultant) towards hiring more FTEs in hospital IT. This makes sense. As the EHR product has matured, the manpower needs are more stable and so it makes a lot of sense to hire a full time person to manage the ongoing needs.

We’ve seen that first hand on our healthcare IT job board. There are still some lingering consulting positions that are needed for the remaining EHR implementations, but hospitals are hiring more FTEs. I think this trend will continue for a good while to come.

In fact, we’re seeing a shift in consulting. Many EHR consulting companies are turning into EHR help desks. Others are going after value based reimbursement and healthcare analytics. In some cases, the consulting companies are turning into product companies. In other cases, they’re finally starting to consult.

Best of Breed in Patient Engagement?

Posted on June 17, 2015 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 I’ve been thinking more about the future of healthcare IT, I wrote that I think the next major healthcare IT product could be a Care Management System. Maybe it will go by a different name, but the functionality that’s described by a care management system is already going into place. Regulations are headed that direction and every organization will need to have a care management system.

At the core of a care management system will be functionality that engages the patient. I use that term in the broadest sense possible and not the fully corrupted meaningful use version of patient engagement. I’m talking about truly engaging the patient in their care in a bi-directional way that includes communication, support, education, social influence, and more.

As I consider the broad possibilities around patient engagement, there are hundreds of companies (possibly thousands) working in this space. Some are working with diabetic patients while others are focused on cardiac issues. Others are using text messages while some startups are leveraging full smart phone applications. A few tie in with the EHR vendors and many don’t. A hospital system is going to need a patient engagement solution that cuts across all of these slices.

With that in mind, it begs the question, “Are we going to implement and manage a cobbled together “best of breed” solution for patient engagement?

If EHR history tells us anything, most hospitals will adopt some point patient engagement solutions and then over time they’ll realize that the best of breed approach to patient engagement has gotten unwieldy and they’ll start looking for an all in one patient engagement solution. In some ways, this has to be the path forward. There’s no all in one patient engagement solution today. So, hospital systems have to choose to either sit on the sideline and wait for the all in one system to arrive (like many did with EHR software) or they have to go best of breed to start while the all in one patient engagement solutions come together.

I’m not sure this path is such a bad thing. It’s good for a health system to understand patient engagement in a smaller way before expanding across the entire system. We’re starting to see more of this happen in hospitals. However, be sure to keep your eye on the long game being one unified patient engagement system.

Moving from the Era of Push to the Era of Pull for Healthcare Data

Posted on June 15, 2015 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 thought this image and comment were really interesting in the context of healthcare data. Healthcare data has generally been stuck in the push era. I’m excited to see the discussion expanding to the pull era. It’s a very different world when you can just pull the healthcare data you want when you need it. The above conference is from a medical imaging conference. Are they leading the way with pull data in healthcare?

We’re Entering the 15th Year of Our EHR Implementation

Posted on June 12, 2015 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 was recently talking to someone about a major progressive hospital system that’s been using technology and EHR for a long time. This person then told me that it felt like this hospital system was in its 15th year of its EHR implementation.

I’m sure that most hospital organizations can relate to this statement. Each hospital system will replace the number of years with a different number, but I think every hospital probably believes that their EHR implementation is never complete. Certainly you might have a go live event with the initial installation of the software, but that’s far from a fully implemented EHR system.

This concept reminds me of two things we’ve talked about before. The first is a controversial post I did called The Tyranny of “Time” – EHR Efficiency Has a Lifecycle. I put up a chart which I think illustrates an important lesson about the lifecycle of an EHR implementation and many disagreed with the chart. I still stand behind the principle that time has a way of eroding even the best EHR implementation. So, you better have a long term plan to deal with the Tyranny of Time.

The second is a comment from a hospital CIO who made a comment on one of my posts many years ago. In the post I’d commented about how we’d implemented a new practice EHR in about 2 weeks time frame. The doctor was opening his practice in 2 weeks and so we literally crunched in the entire EHR implementation and purchasing process into those 2 weeks so they didn’t have to start on paper charts. The Hospital CIO’s comment on that article was “You lost me at 2 weeks EHR implementation.” Of course, this was an EHR implementation at a solo practice.

Although, even in the case of a small ambulatory practice, the EHR implementation is never done. At hospitals there’s always more that can be done to improve how you use your EHR. I don’t think it’s a bad thing to think that you’re in your XX year of your EHR implementation. As long as you still create milestones so that staff feel the sense of accomplishment in the process.

Even Without Meaningful Use Dollars, EMRs Still Selling

Posted on June 10, 2015 I Written By

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

I don’t know about you, readers, but I found the following data to be rather surprising. According to a couple of new market research reports summarized by Healthcare IT News, U.S. providers continue to be eager EMR buyers, despite the decreasing flow of Meaningful Use incentive dollars.

On the surface, it looks like the U.S. EMR market is pretty saturated. In fact, a recent CMS survey found that more than 80% of U.S. doctors have used EMRs, spurred almost entirely by the carrot of incentive payments and coming penalties. CMS had made $30 billion in MU incentive payments as of March 2015. (Whether they truly got what they paid for is another story.)

But according to Kalorama Information, there’s still enough business to support more than 400 vendors. Though the research house expects to see vendor M&A shrink the list, analysts contend that there’s still room for new entrants in the EMR space. (Though they rightfully note that smaller vendors may not have the capital to clear the hurdles to certification, which could be a growth-killer.)

Kalorama found that EMR sales grew 10% between 2012 and 2014, driven by medical groups doing system upgrades and hospitals and physician groups buying new systems, and predicts that the U.S. EMR market will climb to $35.2 billion by 2019. Hospital EMR upgrades should move more quickly than physician practice EMR upgrades, Kalorama suggests.

Another research report suggests that the reason providers are still buying EMRs may be a preference for a different technical model. Eighty-three percent of 5,700 small and solo-practitioner medical practices reported that they are fond of cloud-based EMRs, according to Black Book Rankings.

In fact, practices seem to have fallen in love with Web-based EMRs, with 81% of practices telling Black Book that they were happy with implementation, updates, usability and ability to customize their system, according to the Q2 2015 survey. Only 13% of doctor felt their EMRs met or exceeded expectations in 2012, when cloud-based EMRs were less common.

Now, neither research firm seems to have spelled out how practices and hospitals are going to pay for all of this next-generation EMR hotness, so we might look back at the current wave of investment as the time providers got in over their head again. Even a well-capitalized, profitable health system can be brought to its knees by the cost of a major EMR upgrade, after all.

But particularly if you’re a hospital EMR vendor, it looks like news from the demand front is better than you might have expected.

Behold The Arrival of The Chief Mobile Healthcare Officer

Posted on June 9, 2015 I Written By

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

Managing fleets of mobile devices is an increasingly important part of a healthcare IT executive’s job. Not only must IT execs figure out how to provide basic OS and application support – and whether to permit staffers and clinicians to do the job with their own devices – they need to decide when and if they’re ready to begin integrating these devices into their overall lines of service. And to date, there’s still no standard model using mobile devices to further hospital or medical practice goals, so a lot of creativity and guesswork is involved.

But over time, it seems likely that health systems and medical practices will go from tacking mobile services onto their infrastructure to leading their infrastructure with mobile services. Mobile devices won’t just be a bonus – an extra way for clinicians to access EMR data or consumers to check lab results on a portal – but the true edge of the network. Mobile applications will be as much a front door to key applications as laptop and desktop computers are today.

This will require a new breed of healthcare IT executive to emerge: the mobile healthcare IT leader. It’s not that today’s IT leaders aren’t capable of supervising large mobile device deployments and integration projects that will emerge as mHealth matures. But it does seem likely that even the smartest institutional HIT leader won’t be able to keep up with the pace of change underway in the mHealth market today.

After all, new approaches to deploying mHealth are emerging almost daily, from advances in wearables to apps offering increasingly sophisticated ways of tracking patient health to new approaches to care coordination among patients, caregivers and friends. And given how fast the frontier of mHealth is evolving, it’s likely that healthcare organizations will want to develop their own hybrid approaches that suit their unique needs.

This new “chief mobile healthcare officer” position should begin to appear even as you read this article. Just as chief medical information officers began to be appointed as healthcare began to turn on digital information, CMHOs will be put in place to make sense of, and plan a coherent future for, the daily use of mobile technology in delivering care. The CMHO probably won’t be a telephony expert per se  (though health systems may scoop up leaders from the health divisions of say, Qualcomm or Samsung) but they’ll bring a broad understanding of the uses of and potential for mobile healthcare. And the work they do could transform the entire institution they serve.

FDA-Approved Digital Health Should Save $100B+ Over Next Four Years

Posted on June 8, 2015 I Written By

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

Here’s some research which suggests that a lack of “medical grade” digital health tools is perhaps the final obstacle holding healthcare back adopting them full scale — and reaping the benefits.

Accenture released a study last week concluding that FDA-regulated digital health solutions should save the U.S. healthcare system more than $100 billion between now and the next four years.

The scant number of digital health solutions the FDA has already approved has already had a meaningful impact, generating $6 billion in cost savings last year courtesy of improved med adherence, fewer ED visits and digitally-supported behavior changes, Accenture reports.

But that’s just a drop in the bucket, if Accenture is right. The consulting firm expects our health system to save $10 billion this year thanks to use of such devices. And then, as the FDA approves more digital health technology, the savings figure should make dramatic jumps over the next few years, hitting $18 billion in ’16, $30 billion in ’17 and $50 billion in ’18.

What’s intriguing about these numbers is that they assume each FDA approval will seemingly generate not only more savings, but also a cumulative “whole is greater than the sum of its parts” effect.

After all, in raw numbers, the number of devices Accenture is relying on to achieve this effect is small, from 33 approved last year to 100 by the end of 2018. In other words, 67 devices will help to generate an additional $44 billion in savings.

That being said, what makes Accenture so sure that the ever-so-slow FDA will approve even 70-odd devices over the next few years?

* Provider demand:  At present, about one-quarter of U.S. doctors “routinely” use tele-monitoring devices for chronic disease management, researchers found. As hospitals and medical practices look to integrate such solutions with their core EMR infrastructure, they’ll look to please providers who want digital health tech they can trust.

Reimbursement shifts:  Accenture argues that as value-based reimbursement becomes more the norm, health leaders will increasingly see digital health solutions as a means of meeting their goals. And medical device providers will be only to happy to provide them.

Regulatory conditions: With FDA guidelines in place specifying when wellness tools like heart rate monitors become health devices, it will be easier for the FDA to speed up the process of digital health technologies, Accenture predicts. This should support 30% annual growth of such solutions through 2018, the study found.

Consumer health tracking:  Consumer demand for health tracking devices, especially wearables, should continue its rapid expansion, with the number of consumers owning a wearable fitness device to double from 22% this year to 43% by 2020, according to the consulting firm.

While Accenture doesn’t address the impact of digital health tech that doesn’t get FDA approval, there’s little doubt that it too will have a significant impact on both health outcomes and cost savings. Ultimately, though, it could be that it will take an FDA seal of approval to get widespread adoption of such technologies.

Hospitals Favor IT Investments Over Cash on Hand

Posted on June 5, 2015 I Written By

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

Today I was reading a piece in Healthcare Finance News concluding that now more than ever, hospitals are being judged by financial analysts by the number of days’ cash they had on hand. At the same time, the story noted that hospitals are facing some of the biggest financial stresses they’ve faced in decades, with high patient deductibles and copays leading to drops in collections, switches to risk-based compensation cutting margins and the ever-present need for EMR and other IT investment looming.

When you boil all of this down to the essentials, you’ve got a pitched battle going between the need for current liquidity and the need for future liquidity. While having cash on hand shored up for a rainy day makes analysts like Moody’s happy, failing to spend on the right IT infrastructure undercuts the chances of making it work a few years in the future.

After all, if you don’t have a current revenue cycle management system in place, payments can slip through your hands that could have been collected.  Without spending the right amount in (on the right product, at least) on tools that help manage risk-based contracts, health systems and ACOs can end up losing big money on these contracts.

And even hospitals that aren’t in robust shape are betting their financial future on big EMR investments because they clearly consider it necessary to do so. For example, as I noted in a post earlier this year, Chattanooga, TN-based Erlanger Health System just committed to a 10-year, $100 million deal to put Epic in place despite its only recently having recovered from serious financial challenges.

So the question becomes whether hospitals can risk being cash-poor for now — at least by one measure — in an effort to keep the IT tools they need at hand. Obviously, there’s no one-size-fits-all answer, but industry strategies seem to offer a hint.

The reality seems to be that many health systems and hospitals feel they need to invest in IT upgrades and new technologies whether the traditional metrics fall into line or not. As scary as the regulatory issues (such as the ICD-10 upgrade) and changes in compensation are, health organizations like Erlanger are making the bet that even if it makes them uncomfortable now, having the right IT in place is a must-do.

While I’m no financial genius, my guess is that this means hospitals are going to voluntarily let key metrics like DCOH slip in favor of building for a solid future. I suppose we’ll know in five years or so whether taking such a risk pushed a bunch of hospitals over the cliff.

Hospitals Test New Early-Warning Systems

Posted on June 3, 2015 I Written By

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

The following story offers some tidbits on how new technologies, some EMR-based and some offering independent forms of patient monitoring, are popping up in hospitals.  I found the technologies profiled to be quite interesting and I think you will too.

According to a new piece in The Wall Street Journal, U.S. hospitals have begun to test wireless monitoring systems to track the condition of potentially unstable patients, such post-surgical patients or those on narcotic meds that can suppress breathing. The new technology is most popular on med/surg units where patients aren’t generally monitored 24/7 for changes that can prove fatal.

One approach hospitals are adapting is a wireless monitor which is placed under a mattress and tracks patients’ breathing and heart rate. The monitors, which were developed by an Israeli firm called EarlySense, also lets nurses know when patients get out of bed and when to turn them to avoid bed sores. According to the WSJ, EarlySense costs between $80,000 to $200,000 for a 30-bed unit; prices vary depending on how big the hospital is and how many features the product includes.

Academic research is already suggesting that such monitors can make a significant impact on patient care in hospitals. One study appearing in the American Journal of Medicine last year found that use of the wireless monitors was correlated with both shorter stays and a lower rate of code blue events as compared to units that didn’t use the monitors.

Another technology, software known as the Rothman Index, cross-references 26 variables in medical records and uses them to score a patient on a scale from 1 to 100, with lower scores suggesting that the patient needs to be watched more closely or receive immediate help. The software, which costs roughly $150,000 for a 300-bed hospital, places updated scores regularly on a graph. Some 70 hospitals already have the software in use.

The University of Pittsburgh Medical Center children’s hospital will soon join that number, rolling out a pediatric version of the Rothman Index software in June. UPMC, which has always invested heavily and inventively in new HIT approaches, chose to implement the new software after a research study appearing in Pediatric Critical Care Medicine found that it could effectively supplement staffs’ effort to track kids.

Yet another technology, used at Brigham and Women’s Hospital in Boston, rates patients’ risk of developing serious problems in real time, by analyzing patterns found in lab results, vital signs and nurses’ assessments gathered from EMRs.

Regardless of how you slice it, it’s clear that hospitals are poised to make big leaps in how they monitor patients on the verge of destabilization. This looks like a very promising set of approaches.

Partners Goes With $1.2B Epic Installation

Posted on June 2, 2015 I Written By

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

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.

As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.

The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.

The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.

Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)

According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.

Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.