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Make Back EMR Costs By Collecting Doctor MU Incentives

Posted on September 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

OK, before you start thinking this is too good to be true, please note that what I’m about to describe comes straight from the mouth of a lawyer writing for the American Bar Association.

In a recent item, attorney Abigail Wong Grigsby notes that while hospitals certainly have a chance to collect some nice Meaningful Use payments, they can do a lot better if they pick up their providers’ incentive payments too.

Apparently, through a process known as “EHR assignment,” hospitals may establsh contracts with doctors in which they hospital gets the MU incentive payment that doctor would have received.

It’s worth noting that no one can force providers to sign such agreements, and they may in fact refuse if they’re struggling with the EHR or has a bad relationship with the hospital generally.

Generally speaking, though, hospitals are able to strike such deals when they’ve already gone to the trouble of choosing, buying and installing a certified EHR — then shared it with community providers.

What’s sweet about this arrangement is that even if the hospital itself doesn’t qualify for MU incentives at present, it can still set up the EHR for providers then at least try to get assignment of provider incentives.

As you can imagine, there’s a wide variety of legal nuances involved in determining which hospitals can legally collect from which providers. (For example, you can’t get your provider’s benefits assigned to your hospital if you’re not conducting billing and collecting services for that provider, the article notes.)

Since I’m far from being a lawyer, I’m going to stop here and leave it to you to review this excellent, in-depth piece directly.

What I’d take away here, though, is that there may be more ways than you’d thought to subsidize that beastly expensive EHR.  Don’t let the legalese turn  you off;  Ms. Grigsby’s advice is definitely worth a close look.

Hospitals Giving Data Security Way Too Little Attention

Posted on September 14, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

I’m not exactly an innocent flower, I wasn’t born yesterday and I didn’t just fall off the turnip truck.

Still, I have to say that I was a bit surprised and disheartened  by the news that popped into my inbox yesterday. It seems that despite having countless reasons to do so — including, of course, the rollout of new EMRs — hospitals haven’t cleaned up their security act much.

According to HIMSS research, less than half of hospitals are doing an annual security risk assessment, according to a new article in Information Week.

The story, which sites a new report from consulting firm CSC, notes that under both Stage 1 Meaningful Use rules and proposed Stage 2 rules, hospitals need to conduct annual risk checks and fix any problems they find.

And then, it reminds us, there’s also tougher HIPAA security requirements on the way, which are likely to require such assessments, as well as demanding new security breach notifications and extension of security requirements to business associates.

But according to HIMSS data cited in the story, only 47 percent of hospitals currently conduct such annual risk assessments, and 58 percent of HIMSS survey respondents didn’t have a single staff member dedicated to security.

Now, as writer Ken Terry appropriately notes, it’s not that that data security isn’t on hospitals’ radar.  When HIMSS surveyed CIOs for its 2011 Leadership Survey, it found that 30 percent said that complying with HIPAA and CMS regs was their biggest security issue.

Still, it seems to me that hospitals are skating on thin ice. What I see in these numbers is IT leaders who are in “hope and pray” mode where data security is concerned, an irresponsible position at best.

Yes, I know, security professionals are hard to find and expensive to retain. I realize that simply maintaining and implementing health IT systems is more challenging than ever in the post-EMR environment. And of course, I realize that virtually all hospitals do have meaningful security measures in place, even if you aren’t checking in on them as often as you’d like.

That being said, I doubt your hospital is ready to pay the price of a security breach, particularly in an era where it the costs include possible CMS sanctions, fines, a public relations nightmare — plus, quite possibly, a heck of a lot of backtracking and hasty patching of systems.  Compared with what an EMR breach could cost, spending even $100K a year for a security specialist is peanuts for all but the smallest players.

I sincerely hope hospital CIOs get in gear quickly on this issue. If I can hardly believe what I’m reading, the feds aren’t going to be too forgiving either.

Small HIT Grant May Make Big Difference For Rural Hospitals

Posted on September 12, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Really, what can you do with a $12 million dollars IT budget? Perhaps it could launch one solid EMR at a mid-sized hospital, but it’s not likely to stretch much beyond that in suburbia.

Fortunately, the economics of IT are different in the hinterland. It looks like the $12 million HHS plans to dole out to rural hospitals may have a real impact on their efforts to adopt EMRs and meet Stage 1 Meaningful Use requirements.

Under the HHS program, which was developed as part of the president’s Rural Health Initiative, about 40 organizations will get about $300,000 each in health IT funding. The grants will help rural hospitals to buy technology, install broadband networks and pay for training.

The Obama administration is also offering loans to more than 1,300 rural, critical access hospitals to buy health IT, notably systems designed to raise the quality of care, according to Information Week.

OK, now you’re going to see my prejudices on display. So here goes.

Everything I read and see suggests that rural hospitals can make great use of EMRs and other forms of high-level health IT. So, if it were up to me, the feds would spend far more helping critical access hospitals get up to speed than paying off community hospitals to do what they have to do anyway.

Not only does health IT help rural systematize care, it also lays the foundation for creating effective HIEs.

And in my book, rural facilities need help with HIEs far more than suburban hospitals. After all, if anything, rural hospitals operate on even slimmer margins than their urban/suburban peers.

I’d like to see more projects like this one, in which two rural hospitals got together to share the costs of their Meditech EMR launch. But that kind of partnership is something that won’t happen every day, as such a match requires a unique level of compatibility.

If they invest in rural hospitals, though, the feds could do much to foster such partnerships. I hope to see them do so!

Hospital EMR Apps Hitting The Market

Posted on September 9, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Adding a iPad-friendly front end to EMR apps is a brain-dead obvious move — but vendors move at their own pace. Thus it is that enterprise EMR vendors are just getting around to kicking out front-end apps for their systems, a year or more after the iPad landslide hit medicine.
Perhaps the most recent vendor to develop an EMR app is SAP, which plans to make one commercially available by late October, according to mobihealthnews. The SAP app will be piloted by three European hospitals. (Check out a lovely screenshot of the EMR app, buried in the center of a ZDnet story.)

SAP’s app will do all the expected tricks, including access to patient data, med history, allergies and radiology images. It will also offer a real-time view of patient vital signs, something I’d argue every EMR app should provide.

At least two other major vendors have also gotten into the iApps game. A few weeks ago, for example, GE launched a front-end app for its Centricity Advance EMR, which serves practices with less than 10 physicians.

At the front of the line, surprisingly, was Epic, which released its iPad app Canto just over a year ago. To create Canto, Epic redesigned its iPhone EMR app Haiku and redesigned it for iPad use. I say “surprisingly” because as most readers know, Epic isn’t known for being fashionably current in its technology. (The MUMPS/Cache database at its heart is a dead giveaway.)

Not to sound too slavishly pro-Apple, but as I see it, there’s little excuse for major EMR vendors to avoid the iPhone/iPad platform.  The iPhone is at least as popular among doctors as it is among the general population, and the iPad is increasingly becoming important in the practice of medicine.

Let’s hope we see the other enterprise EMRs snap to and roll out apps pronto.

Small Hospitals Work Together On EMR Install, Save $600K

Posted on September 8, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Installing an EMR can be a lonely job for a small, independent hospital. After all, when you’re about to make a make-or-break IT investment decision, it’s particularly tough to do without the financial backing of a powerful health system or corporate office.

But what if such hospitals were to work together on their EMR projects? Would it help them over installation hurdles and improve efficiency? Would sharing data help justify the costs of their efforts? It looks like two Pennsylvania hospitals are about to find out.

McConnellsburg, PA-based Fulton County Medical Center, an 88-bed not-for-profit, is working with 90-bed Jersey Shore (PA) Hospital to install a Meditech EMR.

The two are connecting their EMR installs via a fiberoptic network laid in by the Pennsylvania Mountains Healthcare Alliance, a local trade group which counts 20 area hospitals as members. But the install, which will also include financial and human resource applications, is being paid for and managed solely by the two small hospitals.

While the installation would usually cost $2.3 million per hospital, the two expect to save about $300,000 each by sharing training, installation and hardware costs, according to Carey Plummer, CEO of Jersey Shore Hospital.

The two critical-access hospitals will also have an easier time meeting Meaningful Use goals by 2013, Plummer told the Williamsport Sun-Gazette.

Unfortunately, I doubt this otherwise smart initiative can be duplicated across the hospital industry. In my opinion, few larger hospitals could create a rollout plan both could live with, much less share a network and common hardware.  (I’m no security expert, but the idea of sharing that much mission-critical data gives even me the hives.)

Not only that, most hospitals that would benefit from EMR sharing in a given metro are likely to see each other as competitors. They’re not likely to partner on valet parking, much less a joint IT project.

Still, it’s encouraging to see small hospitals find a way to make their EMR rollout a success. I applaud Jersey Shore and Fulton County for putting together such a sensible and cost-effective effort.

Would An EMR Have Improved My Son’s ED Care?

Posted on September 6, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Sure, EMRs can make some care processes better, but do they have an impact which patients would notice quickly from their first moment on?

After watching my son spend about seven hours in a pediatric ED waiting to be admitted – as part of a seemingly EMR-free process – I found myself wondering whether the presence of one would have made a difference.

The facility itself is a very reputable children’s hospital, one which attracts not only top physicians but also some of the sharpest pediatricians-in-training to its residency programs. And it doesn’t lack money to throw at EMR adoption. But from all appearances, digitizing records isn’t high on its agenda.

During our visit, the staff was very attentive, paying minute attention to my little one’s concerns despite his being in a particularly fractious mood.

At each stage in his evaluation, I had the sense that staff members had shared information effectively with each other (though admittedly, three different people did have to photocopy his insurance card).

The on-call resident summoned to evaluate him for admission was even lower-tech, if possible. During her interview with him, she took only a few brief notes on sheet of paper covered with jottings of various kinds.  She seemed to capture everything necessary for planning his care.

As I had questions, I stuck my head out into the old-fashioned workstation area and lobbed them over to the charge nurse. She found out whatever I needed to know, and when I had a bit of extra background to offer, she captured it quickly.

Of course, there was plenty of high-tech equipment in the ED, and it played a role in my little man’s encounter. But during his entry process, at least, information was gathered, summarized and shared effectively using purely old-fashioned methods.

If his care had been documented with an EMR, I know things might have worked a bit more smoothly during future visits, as the facility would already have the basics of his background on file for easy reference.  But wouldn’t a robust PHR do the job just as well?

Any physicians involved in his care would probably access the old triage and interview notes via their iPad or smartphone, making them more prepared when they arrived to chat.  Still, the resident on his current case knew nothing when she got here, and things went fine.

The hospital, and physicians, could use the data on his case to gather a better picture of how they’re treating kids with his diagnosis.  Not much to gather in this case, though. Does the possibility of adding him to some registry or dataset justify the expense of doing so via a Cerner or Epic investment?

Ultimately, I can’t think of any way an EMR would have offered a direct, concrete benefit to him this time around.  If not, why should I care that nobody involved in his care used one?  More importantly,  for this forum,  why should the hospital care?

Why *Aren’t* Social Media Tools Used In EMRs?

Posted on September 3, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Like it or not, social media has proven to be the most vital, efficient, inexpensive information-sharing medium in the history of the planet.  From revolutions in Europe to earthquakes in New England, social media has spread news to astonishingly large audiences, many of whom needed little more than a $10 phone to get involved.

Not only that, social media is the best human-knowledge multiplier imaginable. Admit it — even if you hate Twitter, you’ve gotten bits of information there that you’d never, ever find otherwise. And if  you’re like me, that information may well have turned into a host of new insights, which get tweeted and exploded out further. It’s this generation’s version of nuclear fission.

But EMRs, unfortunately, don’t include social media-style sharing.

Why? Well, one obvious reason is that people in the database business, which is how I’d ultimately categorize EMR vendors, are a rather conservative group. (Hey, you can’t have the people managing your most critical data running around with lampshades on their heads.)

Another is that the social media networks are notoriously, terrifyingly insecure — in fact, they’re the ultimate in information exposure. While private social media tools wouldn’t offer access to, say, 500 million Facebook users, the idea still lingers in peoples’ minds.

But I think the issue runs deeper than that. The truth is, the database is a linear concept, even if its design is fluid. The intention, even if someone stacks decision support tools on it, is ultimately to make sure that enterprises have all their data ducks in a row.

Social media aims at those ducks, shoots them and blows away the feathers. Its purpose is to continually remake how information is correlated — to create new contexts for knowledge rather than associate pieces of existing knowledge with each other. In the final analysis, social media information sharing does what databases wish they could do.

I say, it’s time that EMR vendors get over themselves and start using the massive scalability, context-generating capabilities and info-sharing tools social media offers. Isn’t that just what we need?

After all, hospitals don’t exist just to collect patient data; ideally, they leverage it to improve the practice of medicine as a whole. And how better to learn new things than to adopt an approach known to redefine assumptions on a daily basis?

Why aren’t we demanding that EMRs include social media mechanisms for sharing patient data, say, in the cloud, so elegant that they’d make Biz Stone cry?  Where is the impatience? The sense of outrage, even? It beats me.

Ready Or Not, Cloud-Based EMRs Getting More Popular

Posted on August 26, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Several days ago, I wrote a piece griping about the vague use of the term “cloud” in describing networking strategy — and particularly, the notion of the cloud as platform upon which to deploy an EMR. My gripes didn’t even take on the idea of whether virtualized EMRs were a smart approach; I was just troubled by the way vendors were throwing the term around, and perhaps selling vastly different products under the same moniker.

Well, I give, at least for the moment. The more I read about cloud deployments of EMRs,  the more it appears that something useful is going on.  (Cloud security is still a question mark, but that’s a subject for a whole ‘nother article.)

If nothing else, cloud-based models of EMR deployment seem to be easier and more flexible to use than some SaaS models, as client users almost certainly won’t need to download additional apps or even browser scripts to use them.

Some recent examples of cloud deployments in the hospital setting:

* This month, a pair of London hospitals began storing patient data in the cloud. The two hospitals, Chelsea and Westminster Hospital, are part of a National Health Service pilot known as E-Health Cloud. Since writing this item up in July, I’ve learned that the private cloud effort will be supported by a Scottish cloud vendor named Flexiant.  To fend off worries over security, users will have to pass multiple ID checkpoints to get to patient data.

*  Hudson, NY-based Columbia Memorial Hospital has maintained a private cloud-based platform to support its eClinicalWorks system since early 2010, one which serves 26 clinical locations and 300 providers.  Hospital CIO Cathleen Crowley told SearchHealthIT that the cloud approach has allowed the facility to use less physical servers and minimized the hospital’s need for IT support for the EHR. (Interestingly, the hospital is also participating in a pilot HIE project, bolstered by a $1.03 million grant from the state’s Department of Health.)

* Harvard Medical School and Beth Israel Deaconess Medical Center have taken what leaders see as the best of the public and private cloud models to provision their EHR.  As defined by then-CIO John Halamkha, the public cloud involves rapid provisioning of CPU cycles, software licenses and storage, but no guaranteed service level or strong security. To address these limitations, the two institutions built Orchestra, a 6,000-core blade-based supercomputer, designed to be highly secure and available, as well as adding grid technologies to share CPU cycles among high performing computing facilities nationwide. This superplatform offers a virtualized environment for 150 clinical offices, hosting 20 instances of logically isolated EHR apps per physical CPU. (By the way, I believe these institutions use a home-grown EHR of their own.)

What can we take from these stories? Well, we don’t have enough information to draw scientific conclusions, but it seems that a) building out private cloud virtualization of EHRs can be (very) expensive, but ultimately works well and that b) Securing data in the cloud still takes a long ton of effort.

The next challenge for the vendor community, it seems clear, is to offer a cheaper private cloud infrastructure that hospitals trust. Not sure how long that will take, though. Heaven knows this will prove to be a big challenge.

Hospitals Face Hidden “Paperwork Overhaul” Costs With EMR Install

Posted on August 19, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

If you’re an IT exec, you know things projects rarely cost what you expected them to, and often take longer than  you’d hoped.  Healthcare being the tricky beast that it is, meanwhile, the problem is particularly acute.

Nowhere is that principle better illustrated than by the many “gotcha” costs that pop up when a hospital budgets for an EMR. Not only do many EMRs behave in unpredictable ways, they also have unexpected impacts on your hospital’s workflow and administrative policies.

I particularly like the way blogger R. Dirk Stanley explained the problem in a recent article. As he notes, technical problems may be the least of your worries. Hospitals often face unexpected administrative costs that vendors, let us say, don’t exactly play up in their sales pitch.

Stanley, CMIO of Northampton, MA-based Cooley Dickinson Hospital, describes a scenario in which a hospital picks a vendor to install and set up its EMR and train its staff for a total cost of $10 million.

So far so good? At first, perhaps. But then, the hospital’s IT leadership realizes that it faces some huge hidden costs, notably a “paperwork overhaul” that could include updates to order sets as well as clinical documentation, policies and protocols.

As he notes, paper versions of these four tools may contain overlapping information — something staffers can generally work through — but within an EMR that simply can’t happen, he notes. “You’ll be forced to divide your patient care instructions into one of these four buckets…and this can be expensive,” he writes.

After all, he says, changing these documents is no light matter. You’ll need clinicians to participate in committees which will make and approve changes to these critical tools.  Getting the information entered and checked within the system requires more time and expense. Then, what do you do if the vendor updates the system and you’re forced to reorganize again?  Spend more on updates, of course.

Stanley doesn’t cite a cost-overrun estimate, but my guess is we’re not talking about pocket change. Worse, if your tools update moves slowly, it could lead to delays in workflow reorganization, a costly (and scary) prospect on its own.

Seems to me that this problem isn’t getting enough attention in hospital IT circles. What do you think?

Epic’s Success in the Hospital EHR Market

Posted on August 17, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I took Katherine’s post about Epic Being a Victim of Its Own Success and posted it on Google Plus to see what kind of conversation would happen (Note: You can find me on Google Plus here). Turns out, it’s already generated 15 responses with a bunch of interesting points of view.

Dan Munro just left the following summary of Epic’s success that I thought was definitely worth sharing on this site since it was thoughtful and useful to consider.

1) The KP deal (started in 2003) is estimated to run $4B over 10yrs
2) Kent Gale, president of KLAS Enterprises, a research firm known in healthcare specifically for its customer surveys said “…there’s a huge gap between Epic and the other vendors. That is probably the biggest differentiator. They are able to keep their commitments better.”
3) Epic ranked No. 1 in seven out of 20 categories in one of KLAS’ most recent survey (and they don’t sell products for several of the categories).
4) “They have a reputation for doing the right things,” said Thomas Handler, a physician and research director at Gartner.
5) Founded in 1979 with an initial investment of $70,000, the company now is conservatively estimated by Wall Street analysts to be worth $1.2 billion (2008).
6) Epic has never done an acquisition, has no debt and has been known to turn away business.
7) The company historically has hired only 2% of all applicants.
8) Epic receives about 40,000 to 50,000 applications/year.
9) Epic’s software enabled Kaiser, the country’s largest health system (outside of VA?), to confirm that Vioxx increased the risk of blood clots, leading to the prescription painkiller being pulled from the market.
10) The company rarely negotiates on price. There is one exception: It has been known to give breaks, such as waiving its annual maintenance fee, to struggling hospitals.

Certainly Epic has been doing very very well. I’m not sure anyone would argue against that.