The number of children’s hospitals with EMRs in place — and compliant with Meaningful Use — has increased substantially over the last few years, though minor teaching and nonteaching institutions are not as far along, according to a new study appearing in the journal Pediatrics.
The study, which compares data on EMR adoption from 2008 with data on 2011, collected data from 126 children’s hospitals. Researchers calculated EMR adoption rates by using existing definitions of the key functionalities which make up an EMR. The study also looked at Meaningful Use compliance, which it evaluated by by checking whether a given hospital could meet 12 core Meaningful Use criteria.
The study found that between 2008 and 2011, the number of childrens’ hospitals with an EMR grew from 21 percent to 59 percent. But even using 2011 data, only 29 percent of children’s hospitals had demonstrated that they could meet the 12 core criteria used as a Meaningful Use proxy.
All told, EMR adoption rates and Meaningful Use compliance rates were much higher for childrens’ hospitals than for adult hospitals as a whole. However, the results were similar for adult and childrens’ teaching hospitals.
These results square well with an early 2012 report by HIMSS Analytics which looked at Meaningful Use Stage 1 compliance among hospitals. HIMSS found that teaching hospitals were one of the hospital types most likely to have embraced Meaningful Use.
The question, for me, is when childrens’ hospitals are going to step up further in their Meaningful Use efforts. I don’t know about you, but to me 29 percent compliance isn’t terribly impressive.
I have heard a number of people talk about healthcare big data was all the buzz in the healthcare IT world. There’s little doubt that there’s a lot of conversation happening around big data and analytics in healthcare. While I think there’s tremendous value to be found in healthcare big data, I’ve been more intrigued by what Encore Health Resources calls skinny data.
You can read more about the Encore Health Resources CoreANALYTICS announcement, but the approach is what I find really interesting. Instead of trying to create a huge enterprise data warehouse that can be all healthcare data for everything, they instead decided to focus on created a smaller solution that just focused on one major problem: meaningful use.
Encore Health Resources was open about the reason why they chose to go with a skinny data model as opposed to a full enterprise data warehouse model, time and budget constraints. They basically were asked to produce a result with a limited budget and so there wasn’t time or money to do anything but achieve the desired results. One of the architects of the system said, “If you can give me the extra data for free, then give it to me. If it costs [time or money] more to get that data, then don’t do it. Although, if you don’t give me these other data elements, then I’m going to have issues.”
It seems like a pretty simple concept to me that makes me wonder why I haven’t seen more of it in healthcare. Encore has taken these concepts and started to expand beyond meaningful use and into other areas like at-risk populations, clinical analytics for care coordination, and financial analytics.
I asked them if CoreANALYTICS would eventually grow into what essentially becomes an enterprise data warehouse. They suggested that it wouldn’t likely ever get that large, but I can see a path to that type of result.
What I do love about skinny data is that it’s user the information a hospital has available and creating actual results. It’s one thing to have the data, but it’s what you do with that data that really matters.
I’ve been thinking quite a bit about the new HIPAA Omnibus rules ever since I interviewed Rita Bowen at HIMSS about the new HIPAA rules. While Rita highlights some other changes that came as part of HIPAA Omnibus, I still think that the biggest change is all of the new details around business associates.
There are a lot of changes when it comes to business associates and the work to make sure everything is in place with business associates requires the healthcare institution and the business associates. Considering the HIPAA Omnibus rule went into effect on March 26th, there’s no time for an organization to delay this work. They’re already behind if they haven’t done this already.
Considering the lack of discussion I’ve seen from hospitals, I have a feeling that many of them haven’t dealt with this issue yet at all. In fact, I wouldn’t be surprised if many of them didn’t even really realize that they had to do anything. Instead, I expect that many just figured it was on the back of the business associate to change. That’s just not the case and the hospital should be consulting their HIPAA lawyer to make sure everything is in place.
I’d love to hear if others are having different experiences. Did you go through the HIPAA Omnibus rule? Did you have to make a lot of changes? Did you change how you work with business associates?
One of my goals at HIMSS is to try and give those who can’t attend HIMSS a chance to get a taste of what the experience of visiting the HIMSS exhibit hall floor is like. I’d been doing some writing for Metro on their Point of Care blog recently, and so I took the chance at HIMSS to film Erik VanLaningham doing a demo of some of the Metro point-of-care hospital solutions. It’s a quick video that shows a nice look into BCMA and point of care technologies in action.
Hospitals are making good progress toward achieving Meaningful Use milestones, a new study by HIMSS suggests.
HIMSS, which surveyed 298 healthcare CIOs between December and February, found that 66 percent had already qualified for Meaningful Use stage 1, while another 4 percent expected to do so before the end of 2012, Information Week reports.
Meanwhile, 75 percent of respondents said they expect to attest for stage 2 in 2014, which as readers probably know is the first year of stage two attestations.
Given the ambitions noted by the CIOs, it’s not surprising to learn that 66 percent of them said they thought their budgets would definitely or probably increase this year. Of the remainder, 15 percent said their budgets would remain level, and 8 percent expected to see a decrease.
Last year, achieving Meaningful Use was the hospital CIOs’ top business objective, named by 24 percent of respondents, but this year, it fell to 15 percent. This year, the top health IT business objective has switched over to survival, with 21 percent saying their key goal was to sustain the financial viability of their organizations. This was followed closely by improving patient care, which came in at 19 percent.
Still, Meaningful Use will obviously stay top of mind for the CIOs, who may be better prepared than last year but still have much to handle.
After all, they expect to make serious money on achieving MU goals, HIMSS concluded. The survey found that about 30 percent of hospital CIOs expected an ROI of up to $2 million on stage 1, another 23 percent a return of $2 million to $3 million, and 16 percent expected ROI of $4 million to $5 million.
As hospitals have implemented EMRs, they’ve created a tempting target for criminal hackers, as the goldmine of patient data they house can be very valuable on the black market. At the same time, patient access to health data has expanded dramatically, expanding possible points of failure.
Aware of these issues, hospitals are almost all conducting an annual security risk analysis, but fewer medical practices are on the bandwagon, according to new research by HIMSS.
Since 2008, HIMSS has conducted an annual security survey of healthcare providers, supported by the Medical Group Management Association and underwritten by Experian Data Breach Resolution. That first year, three-quarters of respondents (largely hospitals) said their organization had conducted an annual risk analysis.
For 2012, a total of 303 individuals completed the HIMSS survey, a self-selected Web-based survey. Those responding had to answer qualifying questions which verified that they were involved directly in working with security at their organization.
This year, a full 90 percent of hospitals reported conducting an annual risk analysis, while just 65 percent of physician practices said that they do so. (I’m actually surprised that so many physician groups are doing any kind of audit, but maybe the respondents came from larger practices.)
What’s really interesting, though, isn’t the mere fact that these organizations are taking their medicine and doing their risk surveys. Some other highlights of the study:
* Twenty-two percent of respondent reported a security breach in the last year: While scary to contemplate, it’s nonetheless true that both hospitals and medical practices had a one-in-five chance of being breached this year. Most breaches affected less than 500 patients, but providers can’t count on that being the rule.
* Less than half of the hospitals and doctors had tested their data breach response plan: Auditing your security arrangements is all well and good, but if you’re not sure your data breach plan will actually help you respond to breaches, it’s not worth the (digital) paper it’s written on.
As the pressure mounts to protect EMR data — across patient portals, mobile devices, laptops, desktops and more — let’s hope that physicians catch up with hospitals when it comes to security. Otherwise, I think 2013 may be remembered as the year big ‘n ugly physician practice break-ins dominated the news.
This week, a House subcommittee held a hearing entitled “Is ‘Meaningful Use’ Delivering Meaningful Results?: An Examination of Health Information Technology Standards and Interoperability.” The hearing follows a recent furor over Meaningful Use’s benefits, in which HHS head Kathleen Sebelius was written a stinging letter by a quartet of Congressman arguing that the program might not be pulling its weight.
Lots of interesting discussion took place at the hearing — see a report from the indefatigable HIT blogger and expert Brian Ahier for more background — but for the purposes of this item, I’m focusing on what HIMSS had to say.
HIMSS, which obviously has a massive stake in the topic discussed, is a big Meaningful Use fan. The trade group argues that “Meaningful Use and the Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.”
Not surprisingly, HIMSS showed up in full color at the hearing, ready to defend MU and the progress of health IT generally. HIMSS offered Congress seven recommendations as to how to keep the MU train moving, Ahier reports. Here’s my favorites:
Direct the administration to initiate an appropriate study of a nationwide patient data matching strategy with a report back to Congress.
Support harmonization of federal and state privacy laws and regulations to encourage the exchange of health information across health systems, payers, and vendor systems.
Continue to support and sponsor pilot programs addressing the collection, analysis and management of clinical data for quality reporting purposes to assist providers and provider organizations make informed decisions for public health, patient care and business purposes.
Preclude any additional delay in the nationwide implementation of ICD-10, International Classification of Diseases beyond the current October 1, 2014 deadline.
Other than the ICD-10 recommendation, which will probably be battled down to the last millisecond by some groups, I’m betting most readers would consider these to be reasonable steps. But I could be wrong. And I don’t see a lot here on the nitty-gritty of interoperability, which was the focus of the Congressmen’s ire in the first place. Folks, what would you add to/subtract from this list?
Four congressmen have thrown what could be a monkey wrench into the rollout of Meaningful Use Stage 2 regulations, arguing that Meaningful Use rules are weak and ineffective and that MU incentives have gone awry.
The four have written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.
In the letter, the congressmen somewhat spitefully quote the recent piece from The New York Times which suggests that EMRs are raising costs by encouraging upcoding. “Perhaps not surprisingly, your EHR incentive program appears to be doing more harm than good,” the letter says. (Oh, snap!)
What do the congressmen want? A) To see CMS suspend all incentive payments until “universal interoperable standards” are promulgated, B) to require higher level of performance from Meaningful Users (upping percentages of, for example, transfers that need to be done electronically) and C) to see HHS “take steps to eliminate the subsidization of business practices that block the exchange of information between providers.”
But there is a nuanced conversation to be had here. While I admit I’ve ridiculed the tone of the congressional letter a bit, I think there’s some merit in the complaints. Interestingly enough, the most substantial complaint (letter “C”) in the missive is discussed the least in the text.
Let’s think about what John rightly calls “Jabba the Hutt” EMR vendors. What incentive do they have to change their business practices and make their products interoperable if the only threat to their business is academic discussions about Blue Buttons, The Direct Project and 17 flavors of HL7?
No, my friends, while I disliked the nasty, hectoring tone of the letter, I think we should take the authors’ objections seriously. We are at an interoperability crossroads and there’s no immediate end in sight.
While we have done a lot of in depth coverage of Hospital EHR systems, we haven’t spent nearly enough time on many of the other IT systems that make a hospital a success. I actually think this is true across most of the health IT industry media outlets. The $36 billion of government handouts might have had an influence on this, but it’s unfortunate. While many are distracted by the EHR incentive money, a lot of other beneficial hospital IT systems are getting left behind.
One of those non-EHR software that should be considered by a hospital is an end-to-end patient flow system. When done right, a quality patient flow system can increase patient satisfaction, improve the quality of care, and make a hospital more efficient. All of these are worthy goals for hospitals of all sizes.
Let’s take a few minutes to look at some of the important features that I believe should be incorporated in a hospital patient flow system.
End-to-End – If you’re going to implement a patient flow system, then you’re going to need a system that handles the entire patient flow. Yes, that means it should handle: transport, admitting/transfer, bed management, and discharge. As most of you know, I generally lean towards implementing best of breed software in hospitals as opposed to the all in one software behemoth. You should not follow this best of breed strategy with your patient flow system. If you want something that will kill patient flow, try to integrate multiple systems. Then, sit back and watch the finger pointing. An end-to-end system will avoid these issues, and will be key to a successful patient flow software implementation.
Customizable to Hospital Workflow – This seems like an obvious feature that you’d look for in a patient flow system. Every hospital I’ve seen has unique patient flows all over the place. However, I don’t believe most hospitals spend enough time evaluating how all of these unique patient flows will work with the patient flow system they’re evaluating. Yes, this requires early involvement from clinical staff across the continuum of care, but the benefits of involving staff early will pay off in selecting the right software and later implementing the selected system.
Graphic – There are a lot of times in software development where programmers over use graphical elements to make it look pretty without adding any real value. I don’t think that’s ever the case with a hospital patient flow software. In a fast paced hospital where nurses, doctors and other staff are quickly moving around the hospital, the visual queues of a graphical patient flow software can be life saving.
Mobile, Digital Signage, and Touchscreens – One of the most important parts of a patient flow system is which devices and interfaces it supports. It is one thing to say that a software can be used on a device and another thing to say it should be used on a device. It is well worth taking the time to understand how the patient flow system works across a wide variety of devices. Make sure that the software works well across mobile, digital signage, and touchscreen interfaces. Each one can help you solve a different patient flow challenge.
While at HIMSS, HP recorded a video of Central Logic’s CEO, Darin Vercillo, demoing some of the features of the Central Logic patient flow automation system across the range of HP devices. I think it provides an interesting visual of many of the things I mention above. Check out the video embedded below:
Obviously, you need to take a deeper dive into their patient flow software to see how it will work for your environment. However, I think the video does a good job showing you the potential of what a good patient flow software could look like across a range of devices. Considering the various workflows in a hospital, the right patient flow system will have to be flexible enough to work in a wide variety of settings.
What other things have you found differentiate patient flow software systems? What benefits have you received from a patient flow system? If you haven’t yet implemented one, why haven’t you done so yet? I look forward to hearing your thoughts and experience in the comments.
This post is sponsored by HP Healthcare, however opinions on products and services expressed here are my own. Disclosure per FTC’s 16 CFR, Part 255.
* Hospitals already at Stage 5, 6 and 7 on the HIMSS Analytics EMR Adoption Model (EMRAM)
According to HIMSS researchers, hospitals in the seven categories above are moving faster than their peers when it comes to IT adoption. Hospitals at the high end of EMRAM are moving up more quickly, as well. As hospitals geared up to meet Stage 1, researchers say, the number of hospitals at stages 6 and 7 of EMRAM is growing as well.
As we’ve previously noted here, however, calling this a success would be looking at the nearly empty glass as half-full. Even HIMSS admits that only five percent of hospitals have achieved Stage 6 of the EMRAM model (give or take) and just 1.2 percent are at EMRAM Stage 7.
There is at least a little bit of good news. Of the 585 hospitals surveyed by HIMSS, about half are ready, most likely to be ready or somewhat likely to be ready to collect incentive payments this year.
The hospitals that reported being “somewhat likely” had achieved at least two menu items, and between five and nine of the core items needed to qualify for incentives.
But hospitals with less than 100 beds — generally rural, critical access hospitals — are not doing even as well as their peers. Only 20 percent told HIMSS that they were ready or most likely to meet Stage One goals.
By the way, the HIMSS research included one discomfiting side note, on security. Of the 585 hospitals that weighed in, just 25 percent said that they protected EHR data by conducting and reviewing a security risk analysis, doing needed suricty updfates and correcting security deficiencies. Oops — there goes compliance witih 45 CFT 164.308 (a) (1), the relevant HIPAA security rule. But that’s a tale for a different blog item, isn’t it, folks?