Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Gap Between Small/Rural and Large/Urban Hospitals Closing

Posted on November 7, 2012 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.

As readers know, we’ve been tracking the progress of Meaningful Use uptake, and data has repeatedly suggested that small and rural hospitals were lagging behind. Now, courtesy of Modern Healthcare, comes an analysis suggesting that the EMR gap between small/rural and large/urban hospitals may be closing.

The magazine, which drew this conclusion after analyzing a CMS/ONC database of meaningful users of EMR systems, found that small hospital-oriented vendor CPSI has moved to the number one position among vendors “whose hospital clients have achieved Meaningful Use with systems certified as ‘complete EHRs.’ ”

According to Modern Healthcare’s analysis, CPSI’s 266 hospital clients account for 19 percent of the 1,381 hospitals that have become meaningful users with complete EMRs.

CPSI, which typically serves hospitals of 100 beds or less, can now boast more hospitals with so-called complete EMRs than larger vendors like Epic and Meditech.  Epic has 251 clients which met Meaningful Use criteria for a complete EMR, and Meditech came in third with 173 hospital clients who were meaningful users of complete EMRs.

That being said, this doesn’t mean that the small and rural hospitals don’t face significant barriers when it comes to acquiring — and more significantly, developing sophisticated uses for — robust EMRs.

As the Modern Healthcare piece notes, far more large hospitals adopted an EMR in 2011 (25.4 percent) than did small hospitals (14.7 percent).  There was also a big gap between the percentage of rural hospitals who adopted EMRs (19.4 percent) versus urban hospitals (19.1 percent), according to Mathematica Policy Research.

It’s also worth noting that when last we checked, smaller hospitals were generally far lower on the HIMSS EMR Adoption Model scale.  Smaller hospitals and rural facilities were on average below 2 on the seven point scale, while urban and academic institutions scored much higher.

That being said, I like how Modern Healthcare used vendor data as a proxy for looking at the status of small/rural hospital EMR adoption. Good idea. Any data we have on how hospitals are faring is good data.

Allscripts Loses NYC Hospital Deal To Epic, Files Complaint

Posted on October 11, 2012 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.

Usually, battles over a hospital EMR contract fall below the radar, with only the hospital and vendors the wiser as to what took place during negotiations. But this time, we may be treated to the spectacle of seeing a large health system explain, in some detail, why it chose one vendor over another.

Allscripts, which lost an EMR contract for New York City’s public hospital system, is crying foul over the system’s decision to go with Epic.  Allscripts has filed a complaint over the award of the $303 million contract, which involves tying together 11 public hospitals, 70 clinics, thousands of doctors and more than one million patients, The New York Times reports.

Allscripts estimates that over 15 years, when ancillary costs are included, it would cost $1.4 billion to implement Epic, while its own EMR rollout could be completed for less than half that number.

Right now, the contract is on hold, and won’t be in force until Allscripts’ complaint with a procurement-review board within the city’s Health and Hospitals Corporation is resolved. (HHC runs the public hospital system.)

But Alan Aviles, president of the corporation, doesn’t seem like he’s willing to budge. Aviles told the Times that HHC chose Epic after considering nine vendors over four years. And he argues that Allscripts’ recent management and financial troubles only validate HHC’s decision.

And at the end of the day, Aviles simply doesn’t buy Allscripts’ estimates. “Allscripts and its CEO absolutely know that the $700 million [savings] number they tossed out is fallacious,” Aviles said. What’s wrong with their numbers? Well, for one thing, Aviles says, Allscripts estimated that the application-support team needed to implement the EMR would cost nothing over 15 years, while HHC had calculated that 15-year staff support would cost $357 million.

Readers, I don’t know about you, but I think there’s some degree of truth on both sides.  If Allscripts submitted a proposal assuming no support costs for HHC, they must be out of their minds.  At the same time, though, I’ve never heard of a major Epic installation being anything but the most expensive option, bar none. Seems to me the truth lies somewhere in the middle.

Health Management Associates Makes System-Wide Deal With athenahealth

Posted on September 21, 2012 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.

Cloud-based EMR vendor Athenahealth has struck a deal with hospital chain Health Management Associates that its vendor competitors would die for.

HMA has signed an agreement with athena under which the chain’s 1200+ employed physicians — cutting across 15 states and 300 locations — will now use the vendor’s practice management, EMR and patient communication services. HMA’s 10,000-odd independent physicians will also have access to the systems.

In the announcement, HMA and athena took pains to emphasize that the selection process was a fair and thorough one:

Health Management selected athenahealth after a twelve-month review and due diligence process that involved more than 350 clinical experts, including more than 200 physicians. The evaluation process included detailed questionnaires, onsite and virtual demonstrations, site visits, and clinical template shootouts.

Perhaps those details were included to convince observers that the deal didn’t include some kind of payola. I don’t think doctors are going to be too impressed by the IT talk. (If it were me I’d care about only one demonstration — how it worked for me on Day One.)

HMA may not be the country’s largest hospital chain, but it’s still a heavyweight, operating 66 hospitals spanning 10,330 licensed beds. Its hospitals span Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Washington, and West Virginia.

Particularly given its scale, this deal intrigues me for a few reasons. It raises what seem to me to be important questions:

* Is HMA expecting its independent physicians to dump whatever EMR they may already have in place and switch it out for athena?  Or adopt its practice management module instead of what they use now?  That seems, uh, a bit unrealistic?

* I don’t know what enterprise EMR system HMA uses (do you, readers?) but whatever it is, I doubt it will plug seamlessly into to the athena cloud.  How do the IT types at HMA plan to connect the whole schlemiel?

* If the independent physicians don’t want to adopt the athena package, what will HMA do? Club them like baby seals?  Or just accept that a large percentage of its docs aren’t connected?

#EPICUGM 2012 Offers Tantalizing Hints

Posted on September 13, 2012 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.

This week Epic held its annual user group meeting (#UCG2012 or #EPICUCG), complete with a full-stage Journey tribute, Wayne and Garth and tantalizing promises of neat features to come.

Because we weren’t at the conference, we took a dive into the tweetstream to see what some of the highlights were.

A big crowd

Attendance at the event was enormous, even by the standards of jaded little me:

Funny business

The event kickoff included a tribute to Journey’s “Don’t Stop Believing,” presumably performed by Epic’s multitalented staffers. I liked the Wayne’s World kicker at the end, as did the audience, which seemed to do a lot of un-IT-like giggling.

Happy smiling people

If the tweets are any indication, a fair number of attendees found #UCG2012 to be something of a rush:

Fascinating factoids

Along the way, attendees did some of Epic’s PR on their own, tweeting such facts as:

And there was this interesting note on the relationship between advanced EMR deployment and being an Epic customer:

Features afoot

All of the enthusiasm was fine. I get it: Rah rah rah Yay Epic! But on to some meatier stuff. Apparently some interesting new features are on the way:

 

 

Sadly, though, on the subject of interoperability, no Original Thoughts seemed to be under discussion:

Maybe the whole “walled garden” thing will be fixed by, oh, UCG2020?

What Won’t Happen In #HIT By September 2013

Posted on September 7, 2012 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.

As part of the upcoming National Health IT Week (#NHITWeek), which takes place September 10 through 14th) my august colleague John has written up a list of ways in #HIT is likely to make a difference over the next 12 months.  (He makes some great guesses; definitely give the post a look.)

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?”  Here’s some of my predictions:

* EMR-to-EMR interoperability:  Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

High penetration by HIEs:  With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

Major uptick in open-source HIT  use:  Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

Epic controls the hospital EMR world for good:  Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak.  But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring:  Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs.  I just think we’re going to remain stuck with some of these legacy issues for some time to come.

An Epic Tale: How Queen Faulkner Controls Her Realm

Posted on August 3, 2012 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.

Once there was a queen in a castle in Wisconsin. She had brave armies of stout young health IT soldiers at her disposal, and for a time, her armies handled all the engagements her health IT fiefdom encountered in with relative ease.

Far and wide, people heard of her Epic deeds, and all wanted to partake in the tools of her empire. But lo, it grew, Queen Faulkner’s armies no longer sufficed, and her servants trained IT mercenaries to handle the constant demands her kingdom faced.

Over time, so many were her supplicants that the Queen’s good men and women scarce could do the work they set out to do. However, the Queen was loath to train more mercenaries for, she reasoned, “at some point they could control my kingdom, and that must not be!”

So the Queen wrought a strategem — a compromise she thought might satisfy the demands outside her realm. She made herself sure that candidates for certification would need to pass nearly through the head of a needle to win the honor of engaging in Epic battles.

And thus, the Queen gave control to her IT mercenaries, but not enough to let them come together and rebel against her realm.

But in her desire for control, Queen Faulkner had left herself open to other discontents. The hospital monarchs who sought her tools and protection began to demand more soldiers and armament, and engagements began to become free-for-alls.

Yet, as per her design, the certified mercenary companies were, alas, far too small to meet the needs of full-scale engagements. And the Queen’s own troops were neck-deep in IT code and infrastructure, unable to come to the aide of their fellow Epic soldiers.

Woe to the Epic Queen. Her engagements, yea, they will continue, but will hospital monarchs continue to seek her aid?  Perhaps they need to consider that even great empires have limits…

Cerner Outage Sparks Controversy

Posted on July 27, 2012 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.

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.

CPOE Acceptance Still Slowed Down By Workflow Changes

Posted on May 14, 2012 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.

Computerized Physician Order Entry (CPOE) adoption rates have been very slow over the last few years, but now, driven by Meaningful Use pressure, more providers are adopting such technology.  That being said, a goodly number of providers still haven’t managed to speed adoption, largely due to doctors’ resistance to changes in workflow, according to a new survey.

The survey, in which vendor Imprivata looked at HIT trends, found that 45 percent of respondents were seeing success with CPOE adoption, with more than half their doctors placing orders using CPOE. This represents substantial progress from a few years ago, when I was seeing studies citing total adoption rates below 10 percent.

That being said, 38 percent of respondents said that less than 25 percent of doctors were using CPOE. What’s slowing things down? Sixty-three percent of respondents said that physician resistance to workflow changes was the hangup.

When asked what technologies could speed adoption of CPOE, respondents said single sign-on (74 percent), virtualized desktops (48 percent) and remote/mobile access (46 percent) were all effective ways to engage physicians in CPOE use. I’m not surprised to hear that single sign-on leads the pack; anything that reduces the hassle factor for users has got to be a winner.

By the way, these trends are fairly consistent previous year’s research, in which the vendor found that 82 percent of respondents considered single sign-on a key factor in CPOE adoption as well as meeting Meaningful Use goals.  It’s worth remembering, when talking about SSO, that Imprivata is a security vendor, so take the prominence of that stat with a grain of salt. Still, I thought it was interesting and probably a valid observation.

By the way, Meditech’s solution ranked well at the top for preferred CPOE systems, with 24 percent using it in their facilities. Cerner and McKesson each had 14 percent of responding firm’s business, Siemens 10 percent and Epic 9 percent.

Issues To Consider When Offering Hospital-Subsidized EMRs

Posted on May 11, 2012 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.

Offering subsidized EMRs to doctors may be a good idea, but if they’re smart, the doctors will be very picky about the terms you offer. (After all, if they use your EMR, you’re in effect controlling part of their business!)

So I was interested to stumble over a nice list of questions to  ask hospitals before accepting an EMR deal.  Here’s the list, drawn from the excellent EHR & EMR Insights blog by EMR vendor SRSsoft:

  • Does the hospital EHR have a proven track record in your specialty?
  • Will the hospital EHR workflow be compatible with your practice specialty?
  • Will your physicians be required to exchange data with the sponsoring hospital?
  • Is the system interoperable with other, neighboring hospital systems?
  • Will learning, training, and use of the hospital system interfere with your practice’s productivity?
  • How will support be handled after initial implementation, and who pays for it?
  • Will the hospital’s EHR vendor assist you and your physicians with creating customizable templates?
  • Will the system aid—or obstruct—your ability to qualify for government incentives?
  • If there are problems, will the hospital’s EHR vendor ensure that the system is compatible with pursuing meaningful use?
  • Who will own your data?

I particularly like the questions regarding 1) the EMR’s track record, 2) the impact of EMR training on medical practice’s day-to-day productivity, 3) Whether the vendor would help with creating customizable templates and 4) who would own the data.

It seems to me that too often, partnerships like these are done on the basis of trust between  organizations rather than a detailed assessment of factors like these. Now, don’t get me wrong, trust is a good basis for starting talks on EMR sharing, but hospital and medical practices alike can get very badly burned by a deal like this if it doesn’t work. Let’s hear it for extra skepticism.

Will Next Generation EMRs Be Platform + Stack of Apps?

Posted on April 27, 2012 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.

For quite some time new — at least a couple of years — mobile apps have been appearing on the market to assist physicians with key portions of their work.  That’s good as far as it goes, but unfortunately, most of these apps don’t work well with EMR systems.

To date, EMR vendors have focused on making sure that their product will help hospitals and health systems achieve Meaningful Use, which is of necessity one of IT’s top prioities.  Mobile apps used to access EMRs are often based on remote access to desktops via Citrix, a solution nobody I’ve spoken with seems to like — especially doctors, most of whom seem to find it quite awkward.

But that approach may end up in the trash heap of history if EMRs evolve as one physician entrepreneur predicts. Dr. Lyle Berkowitz, CMO of a new app company called Healthfinch, believes that EMRs should be platforms upon which multiple apps can be built. (Imagine the EMR as a operating environment like Apple’s iOS or Google’s Android.)

Healthfinch,which retrieves refill requests and delegates them for maximum efficiency,  is running at the  Elmhurst (Ill.) Clinic. Healthfinch is extracting data from Elmhurst’s NextGen EMR, something that NextGen didn’t offer on its own.

From what Berkowitz has seen, EMR vendors Allscripts and Greenwway are “leading the charge” in opening up their platforms to allow third-party vendors to build such apps.  Good on ya, Allscripts and Greenway, but if vendors like Cerner, Epic, Siemens and Meditech aren’t coming to the party yet, the idea of an open API is in its infancy at best.

I don’t know about you, but I like the idea of  an EMR being broken up into objects/apps, in theory at least. Do you think we’re going to see EMRs turn into more of an app stack than a single piece of integrated enterprise software?  And if so, how will it work?