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EMR Upgrade Cycles are Painful – Are You Prepared for Them?

Everyone gets so excited and worked up about the initial EMR implementation, but so many discount the effort that’s required for every EMR update cycle as well. Dr. Jayne from HIStalk gave a great first person perspective on EMR update cycles:

I figure I’ve got about two weeks of the good life left and then I’m going to be back in an upgrade cycle with all the standing meetings that entails. I’ll be back in the trenches testing workflows and trying to find defects as quickly as possible so that our vendor can roll them into patches before we go live. Every time we upgrade it reminds me more and more of some kind of military assault. I’m not sure if it’s just the way we run them or a little bit of post-traumatic stress. Maybe it’s a little of both.

I’m also reminded of Heather Haugen’s comments about EHR upgrade cycles: “software upgrades erode adoption over time and so with every upgrade you need a commensurate effort to retrain adoption.” Far too often organizations underestimate the impact and challenge associated with EMR upgrades.

Over the next couple years, those upgrades will likely be tied to an organization’s meaningful use plan. So, those will likely go better than some nebulous EMR upgrade plan. However, those organizations who underestimate the impact of EMR upgrades on their organization will pay the price later.

I know that many believe that in the large hospital space it’s a two horse race between Cerner and Epic. However, when you consider the challenges and costs associated with upgrading those software, don’t be surprised if some smaller scrappy startup can exploit the EMR upgrade opportunity. I don’t think it will happen until after meaningful use and EHR incentive money run their course, but it will happen.

October 7, 2013 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.

Impossible to Say “Wrong EHR”

It seems that the CIO’s are defending the choice of EPIC because it is politically impossible to say they made a wrong choice after so many resources, money and time have been expended.

The above statement is incredibly scary for me to consider. In reality, it’s the opposite of the oft quoted statement, “no one gets fired if you choose IBM.” In healthcare I’ve often heard people say a hospital CIO doesn’t get fired if he chooses Epic.

We’ve all heard about Epic’s tactics for selecting which hospitals can use their EHR. They are highly selective and say no to a lot of hospitals that they don’t think are the right fit for Epic (whatever fit that might be). I even heard one rumor on HIStalk that when an Epic install goes downhill, Epic will offer to pull out and refund all of the money or require that the hospital pay them a lot of money to have Epic send in a recovery team to try and get the Epic EHR install back on track.

When a hospital has invested hundreds of millions and even billions of dollars on a specific EHR software, things can get messy really fast. Imagine you’re a hospital CIO (which many of you that read this site are) that had just spent hundreds of millions of dollars on Epic. Would you be able to go back to the CEO or CFO and say that it was the wrong choice. That’s not an easy discussion to have and I expect very few hospital CIO’s have the gumption to have that conversation.

Although, let’s not put all of this on Epic. Certainly some of the same dynamics are exhibited by all hospital EHR purchases regardless of EHR vendor.

Besides the large contracts that are signed with EHR vendors, the other major reason hospital CIO’s can’t say that they made a mistake in their EHR selection is because of the lack of EHR data liquidity. Once you start entering your data into an EHR, getting it out is like climbing Mount Everest. Only a few people know how to do it, most aren’t successful, and its guaranteed to cost you a lot of money. If EHR vendors would free up the EHR data, it still wouldn’t be an easy decision, but it would help.

December 19, 2012 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.

Cerner Outage Sparks Controversy

Whew!  Cerner isn’t going to live this one down easily. According to reports from the field, Cerner’s hosted EMR service was down for most of Monday, July 23, taking down both hospital and medical practice clients.

HISTalk.com, the beloved scourge of the HIT world, says the event may have taken out Cerner’s hosted network both nationally and internationally. Making things even more nasty, Cerner’s support sites seem to have been down as well.

Cerner, which used the elegantly vague phrase “unscheduled downtime” to describe the event, said that a human error was responsible for the outage but didn’t elaborate. HISTalk tweeter Richard turned said they got e-mail updates from Cerner every 15 minutes, but not every customer seems to have been attended to as closely.

Unofficially, here’s what happened. A HISTalk contributor claims that the problem was due to a mistake by a Cerner network administrator, who, when trying to update DNS records via the management console, received an error and made the change manually.

While doing so, the unfortunate administrator apparently deleted a DNS zone inadvertently. Oops!  At that point, the error was replicated to all servers; and because anything using the zone couldn’t work, the tools to fix the problem weren’t available either. They then had to restore from backup which took some time.

And in the end, how bad was it? Various HISTalk.com reader reports suggested that Cerner’s service was out for all or at least a large part of the day in question. (One reader showed a graphic of a uCern ticket showing 381 minutes of outage time, or more than six hours.)  Some readers reported being so frustrated that they fell back on paper processes for the day.

Now, I realize some folks are going to start tossing out questions like “What does this mean for the cloud?” I’d argue that a better question is “What does this mean for Cerner?”

Really, it’d be premature to start playing the “is the cloud to blame” game just yet.  After all, we don’t all get furrowed brows and wonder aloud “what does this mean for the auto industry?” when a car crashes.  This crash, like automobile accidents, may have everything to do with the specifics of Cerner’s network and little to do with the soundness of the overall technology.

July 27, 2012 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.

Big Hospital Buys Little Hospital via Mr. H at HIStalk

In a recent post on HISTalk, Mr. H is in rare form as he offers some commentary on what happens when a large hospital takes over a small hospital. I hope we get to see more posts like this in the future from him.

Re: our little hospital. News of a potential affiliation with a much larger organization broke out last week. Should I be nervous? How do these things typically go?” I’ve been through the process a couple of times from the big hospital IT side of the table, so here’s my experience in a nutshell, which may or may not be representative (OK, it might be a little bit tongue in cheek):

  1. The big hospital sends its mid-level managers, who make twice as much as your highest paid person, to snoop around and try unsuccessfully to hide their contempt of your comparatively simple but more effective operation.
  2. They say they are there to learn and assist, but in reality they are thinking, “How fast can we rip out their stuff and replace it with products that we already know and therefore are less of a pain for us to support, no matter what users prefer?”
  3. The systems they want to put in your hospital are more complicated, partly because big hospitals like big, complicated products, but also because big hospitals have big egos and manage to make everything 10 times harder than it needs to be because all kinds of job-paranoid mid-level IT managers are always trying to justify their existence by increasing the level of specialization and complexity wherever possible.
  4. Every decision is made on the basis of which option presents the least risk to the IT organization. Risk means anything that could require more employees, increase help desk calls, or put the bonuses of the top IT executives in jeopardy.
  5. Any semblance of being a friendly, well-respected IT operation goes down the tubes as the new suits insist that nobody can talk to anybody without a help desk ticket, IT employees aren’t allowed to solve problems or make changes without reams of documentation, and vigorously enforced PC policies ensure that everybody except executives in IT and Finance are using the same hardware and software that has been dumbed down and locked down so that the lowest level employee in dietary or facilities maintenance can’t do anything that might require a help desk call. Think of this as computer socialism.
  6. Endless meetings will be held in which nobody in the room has the authority to make a decision, but everybody is empowered to veto someone else’s recommendation or insist that the issue be studied further with even more people invited to the table. The chairs in conference rooms never have time to get cold before the next set of IT posteriors land on them.
  7. You will for the first time see ambitious, back-stabbing IT managers trying to distance themselves from their humble programmer or networking origins by wearing a suit at all times and riding herd on their tiny fiefdoms like they are Steve Jobs, except without the charm, vision, passion, and brains.
  8. On the other hand, you will probably get better benefits and possibly a raise, at least as long as your job isn’t too closely identified with one of the systems that will be unceremoniously dumped, in which case you may find yourself attached to it. You may not be able to look users in the eye, but your career prospects may improve because of better training, exposure to systems for which experts are needed, and a more recognizable employer name on your resume. If you are lucky, you may even get to stay on the periphery and avoid the soul-sucking part of the IT organization entirely. You’ll also realize that it’s not just IT described above – pretty much all big-hospital departments stack up to their small-hospital counterparts in exactly the same way.

Great stuff!

February 12, 2012 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.