Hospital CIO | Hospital EMR and EHR

The Cloud and Hospitals

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.

My Surprise Breakfast with Epic CEO Judy Faulkner

One of the highlights of my experience at CHIME 2012 was a surprise breakfast that happened on the final day of CHIME. I actually was a touch late to breakfast after skipping out of a mostly empty room talking about HIPAA (imagine that on the last day of a conference). I got my breakfast and sat down at a table of what turned out to be mostly hospital CIOs.

Meals at CHIME turned out to be a great time to meet, connect and learn from the hospital CIOs that attended. A lively conversation was happening when a lady sat down next to me. I looked up and to my surprise the lady sitting next to me was none other than Judy Faulkner, CEO of Epic. I’m sure she had no idea who I was and I later realized that she likely sat next to me because on the other side of her was a hospital CIO she wanted to apologize to for something that had happened months before.

As an EHR blogger, I admit that I was probably a bit star struck sitting next to Judy. This was probably accentuated by the stigma (right or wrong) that Epic doesn’t like the media very much. So, I decided that rather than probe into Judy like a normal media person (I prefer to be a thought leader as much as I am a journalist anyway), I decided to just sit back and mostly listen.

It made for a really interesting experience since one of the first things Judy talked about was apologizing to this hospital CIO. I’m sure the cynics out there would say that she was probably apologizing because she wanted to further Epic’s business with that CIO. However, that wasn’t the impression I got from Judy. Instead, I got the impression that she had a real feeling of guilt that something she had done had caused other people some amount of trouble. In fact, how troubled she was by something most of us wouldn’t think twice about I think says something about Judy. I think some like to characterize her as a tough, driven, hard-nosed, business woman. Maybe she is in the boardroom, but my experience at breakfast was of her as a very thoughtful caring person.

When I told some of my colleagues about my experience with Judy, she told me I’d been seduced. Maybe she’s right. From my experience I saw a very kind, compassionate Judy.

I’ll wait to share all of the things I learned from my time with Judy for another time, but I did also have an interesting conversation with Judy about Twitter and social media. I think the conversation began because I playfully suggested that she should post whatever we were talking about to Twitter. I say playfully, because I was quite sure I’d never seen Judy on Twitter or any other social media and so I was interested to see her response. She responded something like, “I hope I live my whole life and never go on Twitter.”

While I was partially taken back by the sharpness of her response (Although, thinking back I shouldn’t have been surprised), I replied that “Twitter’s not about ‘what I ate today’ and that there was real value to engaging on Twitter.” To Judy’s credit, she then asked why I thought she should be on Twitter.

My response in the moment was pretty terrible. I told her about Twitter’s ability to “connect people.” While this is valuable to many people, the last thing that Judy wants in her position is more random people connecting with her. After giving such a lackluster response, I decided a broader answer I could have given would be, “Social media is about people and people are the most valuable asset in the world. Social media leverages people in amazingly powerful ways.”

That answer is still not perfect without examples and application, but at least the answer applies more broadly in a way that she could benefit from social media. After this experience, I asked myself if I was doing a keynote on healthcare social media, what would I say?

I’ve already come up with 21 ways to benefit from social media. I’ve also started creating a list of very specific examples of social media in healthcare. If you have more examples, I’d love to hear them in the comments. It only seems fitting that I’d use social media to help me put together this resource, right?

I’m still debating the best way to spread what I gather about healthcare social media, but I think it needs to happen. I still run into far too many people that think that social media is just about what you ate for lunch or your drunken pictures with friends. More people need to be informed about the amazing possibilities with healthcare social media. Plus, next time I happen upon breakfast with Judy Faulkner, I’ll have a much better answer for her.

Call Me Maybe at #CHIME12

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:

Attending CHIME 2012 Fall CIO Forum

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.

Epic EMR ROI

I think we are familiar with the HUGE institutions that have selected Epic. The most famous of these is the Kaiser implementation of Epic which started at $1.2 Billion and was projected to cost $4 Billion. Yes, that is Billion with a capital B for an EHR implementation. I haven’t done any in depth research on the average cost of an Epic installation, but I can’t remember seeing one lower than a few hundred million at the least.

As I consider these numbers, the following question keeps nagging at me: What’s the ROI for an Epic installation?

Don’t get me wrong. I already know about the many EMR benefits. Although, billions or even hundreds of millions of dollars is a lot of money to make up.

The problem is that covering the EMR space as long as I have, I have yet to see someone do a ROI analysis of an Epic installation. If there’s one out there that I don’t know about, I’d love to take a look. Maybe Epic has some, but it’s part of their tightly controlled process for selling their EHR. Although, if the ROI was so good, it makes you wonder why they wouldn’t want that information in the public domain.

A part of me wonders if hospital CIO’s really care about the ROI of an Epic EHR install. Epic seems to be similar to what enterprises use to say about IBM: “Nobody ever gets fired for buying IBM.” Do many hospital CIOs see it as “Nobody ever gets fired that buys Epic”?

No Duh. EMR Implementation Costs Too Much

Courtesy of Information Week, we get the following news: apparently, EMRs cost too much. Stop the presses!

IW magazine has shared data from a poll by KPMG in which the consulting giant surveyed more than 220 hospital and health system administrators. Now, it’s not all bad news. Twenty-five percent of respondents said they were very comfortable with the funding they had for their EMR rollout.

On the other hand, researchers found that 48 percent of respondents were only somewhat comfortable with the budget levels their system planned for EMR deployment, and 9 percent said they weren’t comfortable at all. This despite the fact that 49 percent of the interviewees are more than halfway through their projects.

This suggests a few things, none of which are terribly heartening:

* That roughly half of hospitals and health systems didn’t budget enough or plan for the marathon effort it would take to get these giant engines running smoothly.

* That Meaningful Use incentives, while lovely and all, aren’t doing enough to defray hospital costs.

* That senior hospital and health system managers don’t have a very realistic picture of what it will to keep feeding the EMR beast for the long- term.

* That hospitals won’t even consider appreciably cheaper alternatives like Open Vista (a story in an of itself)

Mind you, it’s easy to forget that hindsight is 20/20, and that industry changes keep throwing these leaders curves. Predicting what an enterprise software installation will cost five years from now is half black art, half SWAG. So I’m not beating up on the CIOs.

I’m just surprised that anyone would be taken aback by the news that CIOs aren’t sure they can pay for all of this EMR wonderfulness. I mean, honestly, are you?

What Hospital IT Software Do We build and What Will We Buy?

In a LinkedIn discussion about this post on Best of Breed versus All In One Hospital IT systems (a good read if you haven’t read it already), Keith Jennings offers this additional insight that many hospital CIOs face every day:

We have an added wrinkle of “build vs buy” – as we have considerable software development resources on hand. My boss describes it as “its not wether we build or buy, but rather what will we build and what will we buy”…

I’m interested to hear insight into this subject. How do you as a hospital CIO or other member of a hospital IT staff decide which things you build and which things you buy? Does this really only apply to large hospitals or hospital systems that can afford to have their own development staff?

I look forward to hearing your thoughts on the subject. It’s a very important question.

Are iPads Good For Healthcare? A Few Video Viewpoints

Within, say, six months of its introduction, bloggers were already waxing rhapsodic over the potential of the iPad to transform the practice of medicine.

Many industry observers still do see the iPad as one of the defining moments in health IT, and many clinicians couldn’t be parted from their iPad with a crowbar.

But these days, as news of iOS security issues become more widespread, hospitals struggle with integrating iPads into their infrastructure and doctors grow weary of the iPad’s awkward data entry format, the elegant device is making some enemies as well as friends. OK, not enemies, exactly, but for some clinicians and IT leaders that early thrill is gone.

Given how perceptions of the device are shifting, I thought it’d be interesting to take a look at three takes on the iPad today. The first is from a hospital CIO, the second an interview with a doctor an Israeli hospital, and the third with a US physician. Check them out; there’s an interesting range of perspectives here.

Meaningful Use Provides Hospital EHR Vendor Lock In

One of the unintended consequences of meaningful use is that it provides a real hospital EHR vendor lock in. Certainly hospital EHR vendors have a pretty significant lock in even without meaningful use. Saying that switching hospital EHR software is a large project is a supreme understatement. However, if that wasn’t lock in enough, meaningful use makes it so that I can’t imagine a single hospital switching EHR software during the 5 year meaningful use cycle.

In a Meaningful Use Monday post on EMR and HIPAA, Lynn Scheps covered the details of Switching EHR software in the middle of meaningful use. So, yes it is technically possible and CMS has covered those that do end up switching EHR software. As the meaningful use stages progress I could even see this happening relatively frequently in the ambulatory EHR arena. I don’t see this happening at all in the hospital EHR arena.

You might ask why? I can’t imagine a hospital going to the effort of reconciling the details of meaningful use between two systems. Not to mention the implementation time for a hospital EHR system is so long that you’d likely lose out on a year of meaningful use money anyway. I don’t see any hospital CIO making this choice.

I made the argument in a previous post that much like ERP software, there will be an opportunity for some EHR software to displace the current vendor. I suggested this is most likely during the renewal or upgrade period. I still think this is sound reasoning and would be the time a hospital CIO could make the case for change. Although, I’m sure that meaningful use and the EHR incentive money will likely mean that many hospital CIOs take the upgrade cost on the chin instead of switching software.

Makes me wonder if EHR vendors will use this to their advantage when it’s time to deal with renewals and upgrades. I’d hope this wouldn’t be the case, but I won’t be surprised if it happens.

Hospitals with EMRs, HIEs Serious About Cloud Possibilities

For a few years, the notion of cloud-based data sharing has been a least a bit controversial, with questions of security, control, throughput and the like slowing down adoption. But it seems like those days may be coming to an end. A new survey by Harris Interactive for the Optum Institute found that more than half of CIO respondents plan to do some cloud investing.

According to the researchers, almost 60 percent of CIOs with both an HIE and EMR in place plan to invest in “cloud-based open systems.” More specifically:

* 36 percent plan to use the cloud for both their EMR and HIE
* 12 percent plan to go cloud for their HIE only
* 11 percent plan to implement only cloud-based EMR technology

According to FierceHealthIT, top reasons for going cloud include access to additional apps, at 57 percent, and access to additional functionality, at 56 percent.

While it’s hard to tell whether the group selected by Harris is particularly savvy, it was interesting to hear that 71 percent of respondents participate in an HIE, and that almost two-thirds actually own the exchanges in question. (OK, I take that back; HIE ownership does seem to me to suggest extra sophistication.) On the other hand, according to the research firm, the HIEs in question are somewhat limited.

All told, these are interesting findings, though not incredibly surprising given that CIOs have to find a way to get interoperable under Meaningful Use Stage 2. My question is whether the cloud implementations (especially security) will differ so much that they defeat the purpose. Let’s hope we don’t end up with another layer of opacity.

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The Cloud and Hospitals

Call Me Maybe at #CHIME12

Attending CHIME 2012 Fall CIO Forum

Epic EMR ROI

No Duh. EMR Implementation Costs Too Much

What Hospital IT Software Do We build and What Will We Buy?

Are iPads Good For Healthcare? A Few Video Viewpoints

Meaningful Use Provides Hospital EHR Vendor Lock In

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