At CHIME 2012 I asked David Tucker, MBA, MHA, FCHIME, VP of National Sales at ESD and Kelly Mulligan, RN, BA, Chief Operating Officer at ESD about how a hospital CIO should plan for an EHR consultant. While we’d love to think that a hospital could just ask for an EHR consultant and have one there the next day, the reality is much different. Sure, you could have an EHR consultant there the next day, but if you want the best EHR consultants it takes some forethought and planning to make sure you get on their schedule. David Tucker, former hospital CIO, talks more about planning for EHR consultants in the video below.
— EMR, EHR and HIT(@ehrandhit) October 19, 2012
What’s really interesting about my tweet above is that the person that asked me why their weren’t young people at CHIME was actually the wife of someone attending CHIME. She was a healthcare IT outsider that was just observing the situation from the outside.
It’s a very good question and all that I could tell this nice lady was, I don’t know. The reality is that CHIME and all the other major health IT conferences should be embracing and facilitating the next generation of health IT leaders. If they don’t then healthcare will be in a bad position. The next generation of hospital CIOs need to learn from the current crop of hospital CIOs.
I know that I ruffled some feathers with my previous post about the “Old Boys Club” of Healthcare IT, but this is another example of it. I was amazed that I was the youngest person at CHIME and by a long shot. The only people that came close in age were some of the vendors participating in the event.
What are we doing in healthcare IT to groom the next generation of leaders? From my view, not very much. It’s unfortunate, because your hospital CIO won’t live forever (as hard as he may try).
Let’s talk about The Cloud and Hospitals for a minute. At a session I attended at CHIME a hospital CIO said, “There’s still a lot of unknown with cloud.”
At first I was a little taken back by the comment. As an IT guy, it seems like cloud has been around forever. Plus, I would bet that every single hospital has a number of cloud based IT systems in their IT environment.
What then could be the unknown issues with the cloud that this CIO was talking about?
I found this really great resource on the IBM website about the cloud and healthcare. They hit on what is probably the biggest unknown with the cloud, HIPAA. Here’s a section which describes why it’s such an unknown.
Cloud providers hold a unique position as BAs entrusted with EPHI. When HIPAA was enacted, the concept of “the cloud” didn’t exist and probably could not have been predicted. Covered entities and other BAs are increasingly choosing to store health information in the cloud.
Then he adds in these cloud challenges:
Transferring data to the cloud comes with unique issues that complicate HIPAA compliance for covered entities, traditional BAs, and now cloud providers themselves. They include issues of control, access, availability, shared multitenant environments, incident preparedness and response, and data protection
All of these should provide any hospital CIO a moment of pause. As another hospital CIO I talked with said, “we’re still doing the cloud, but we are careful about who we work with in the cloud and how we do it.”
I think this will be the reality for the forseeable future. It takes a really well done trusted relationship for a hospital to trust a cloud provider. In the small ambulatory practice space it’s very different since there’s little doubt that the cloud provider can do much better than your neighborhood tech guy. However, this is not the case in hospitals where the decision to use the cloud or your existing in house IT staff and resources is much more complex.
The reality is that every hospital is likely going to have a mixed hosting strategy with some software hosted in house and some software hosted in the cloud. This means that every hospital CIO is going to have to figure out the cloud even if there’s still some difficult to answer questions.
While at CHIME 2012, I had the chance to sit down with David Tucker, MBA, MHA, FCHIME, VP of National Sales at ESD and Kelly Mulligan, RN, BA, Chief Operating Officer at ESD. I learned a lot from them about what’s happening with hospital CIOs. Plus, it was great to get some first hand perspective on the EHR industry from a former hospital CIO (David Tucker) and an RN (Kelly Mulligan).
I pulled out a video camera to capture some of the things we talked about. I’ll be posting a number of videos with them over the next few weeks, but I’ll start with their answer to the question: What differentiates EHR consulting companies? They mention the KLAS EHR consulting form ratings and even talk about hospital CIO’s being burned by EHR consulting companies in the past.
As I’ve mentioned, it was my first time attending CHIME and it was exactly what I expected it to be. A great place to connect with Hospital CIOs and the leaders in the healthcare IT space. At the final reception, CHIME put together a video of many of the people involved in CHIME in a great Call Me Maybe video:
Today I arrived at the 2012 Fall CIO Forum for CHIME. I’ve wanted to go to this event for quite a while. My fellow blogger, Neil Versel, had often told me about how great the event was and so I wanted to see it first hand.
Tonight I heard an almost emotional Farzad Mostashari speak and then got to mingle with all of the CIO’s at the evening event. A few things I’ve already noticed that I found interesting.
First, Farzad has really refined his pitch for healthcare IT. He makes a really compelling case for what’s possible and a really common sense analysis of why we need to start using healthcare IT now. If I were to put a title on Farzad’s talk at CHIME, I’d call it, “Stop with the Excuses, We Can Do Better.”
Everything at the event is high class. You can tell that no expense was spared to make sure that the major healthcare IT contributors are treated well.
I wasn’t that surprised, but it’s unfortunate that I was by far the youngest person at the conference (at least from what I saw). One wife of a CIO I talked with asked why there weren’t more young people present. Then she said, “Don’t these hospital CIOs want to groom the next generation of leaders? Why are they holding on so tightly and not preparing for the future.” It’s a good question I wasn’t really sure how to answer.
There are a lot of really powerful people at the event. It was fun to see Judy Faulkner mingling with people. I saw John Glaser. In many ways, it’s a Who’s Who of hospital health IT.
While there are many Hospital CIOs at the event, there are also a lot of vendor representatives. Not surprising considering the amount of budget these hospital CIOs control.
I was amazed at how many people were “old friends.” You could see that many of those attending have been doing so for years and this was their annual visit with colleagues. As a first time attendee, you’d think that I might not feel very welcome, but the opposite was the case. All of the hospital CIOs I met were very friendly, kind and happy to engage.
More on the event tomorrow. If you’re in Palm Springs at the event, I’d love to talk with you. Just leave a comment below or send me a tweet.
We knew the final draft of Meaningful Use Stage 2 was going to come with as many complaints against it as Stage 1. Given the scope of the new rules, and the importance of following them, hospitals don’t seem to be up at arms to the extent one might have expected.
To start with, it’s worth noting that hospitals are very happy about one change from the draft, the provision that requires Stage 2 compliance to begin in 2014 rather than 2013, though they still have some significant Meaningful Use worries, according to an AHA official quoted in Modern Healthcare. Presumably, the AHA is also psyched that providers will only be required to demonstrate MU for a three month period in 2014, rather than an entire year.
But that doesn’t mean they’re perfectly content. Senior vice president of public policy analysis and development Linda Fishman said in a statement that hospitals are “disappointed” that the rule sets an “unrealistic” date by which hospitals must meet Stage 1 goals in order to avoid being slapped with reimbursement penalties.
Other provider groups are focused on a new provision requiring 5 percent of patients to view, download or transmit health information during a three month period. The College of Healthcare Management Executives’ noted, quite fairly, that providers can’t control what patients do on their own time. If nothing else, making sure patients meet these goals is going to take marketing, workflow changes and some arm-twisting, to say the least, so I feel their pain.
Meanwhile, some non-hospital groups think Stage 2 didn’t go far enough. The requirement that physicians submit an electronic summary of care docs for 10 percent of patients being transferred to a hospital or another provider does far too little to promote data exchange, critics in the HIE world say.
I too am surprised that HIE-type requirements are relatively light (and focused on Direct Project specs). I’m sure that Meaningful Use Stage 3 will address these issues further, but given what our guy Farzad has said about interoperability, it might have been nice to see more progress now.
These days, the number of active health information exchanges is actually mounting, and it seems they’re in much better financial shape than the previous generation of projects. And in what may be another sign of maturity, the HIEs are defaulting to a rather short list of tried vendors, though no single vendor dominates the market.
For several years, HIEs have been mostly talk, and many have risen only to fall again, largely because their business models didn’t work. But these days, the number of HIEs in operation is climbing again — this time sustainably, in my view — and hospitals are putting HIE connectivity at the forefront of their strategic plans.
According to Jason Hess, research executive vice president for KLAS, the HIE market is accelerating, though most of the growth is on the private side.
Hess, who spoke at the CHIME11 Fall CIO Forum last week, noted that the number of private HIEs have increased from 62 to 161 since 2009, one of the bigger jumps this editor has seen in several years. Meanwhile, the number of public HIEs has grown from 37 to 67 since 2009, he said.
Perhaps more interestingly, a short list of vendors seem to have figured out how to deliver the package of services hospitals and doctors want. I say this because according to one industry expert, 70 percent of HIEs use one of ten vendor technologies, while 25 vendors serve the remaining 30 percent.
According to unrelated research from the eHealth Initiative, Axolotl (now OptumInsight) is top HIE vendor to date, serving 22 of the 255 HIEs currently operating in the U.S. A close second is Medicity, which is used for 14 HIEs, followed by Cerner and Mirth, both of which serve nine HIEs.
You won’t be surprised to hear that big guns like GE, Microsoft and IBM are lingering around the fringes, and have by no means given up on the market. If I were an IT exec with a large hospital, and wanted to create my own HIE, I might go to one of them rather than the established players. Why? Because they still need to make their mark and may actually be more accommodating than the more established HIE vendors. (I admit that’s just a hunch though.)
Anyway, much worth looking at going on in the HIE world, and I suspect it will get more interesting over time. I’ll keep you posted.
It’s finally happening. After years of work, hospitals are beginning to qualify for, and even receive, their long-awaited stimulus payments. On the other hand, having to focus on Meaningful Use seems to have drained a lot of resources and bandwidth away from actual EMR/EHR launches.
Last month CHIME (the College of Healthcare Information Management Executives) surveyed 198 members, representing 656 hospitals across the U.S., on how they were doing with the EMR/EHR adoption process.
CHIME found that the nearly all (93 percent) of CIOs surveyed expected to achieve Meaningful Use Stage 1 during the first three years of the MU program, though many are hoping Stage 2 will be delayed so they can catch up.
It also found that the number of CIOs worried about Meaningful Use has fallen — about two-thirds are still worried, down from 90 percent in March 2011 — and that more than half believe their current strategy and apps will get them there.
Thirteen percent of the hospitals responding received incentive payments during the first year of the program, which began October 1, 2010. Four percent got Medicare incentives, while 9 percent were paid by their state’s Medicaid program.
To date, though, just over half of respondents had registered for stimulus funding, and 26 percent had qualified for payments under HITECH, CHIME reports.
Not only that, twenty-one percent of members hadn’t registered because they hadn’t yet bought or installed an EMR/EHR. (Is it really that early in the adoption process still?) It’s particularly surprising among members of CHIME, who seem to be the types who work for more advanced and progressive institutions.
With a full one-fifth of respondents still fretting over compliance and holding off on EMR implementation, is seems cear Meaningful Use has had a paralyzing effect on the process. While it’s spurred some hospitals to action, it’s arguably slowed down just as many who might be moving ahead otherwise.
Worries about Meaningful Use have created a big, huge cloud of smoke around EMR/EHR adoption. It’s not enough that hospital CIOs have to worry about getting it done — they have to get it done to the government’s standards.
I’m not taking a position on whether Meaningful Use is a good thing long-term, or whether the short-term goals are the right ones. But I think it’s fairly obvious that MU has thrown a serious monkey wrench into the usual systems adoption process. I suppose only time will tell whether it was worth the expense, pain and delays it has caused. Honestly, though, I doubt it.