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The Place of EHR in the Hospital IT Ecosystem

Posted on August 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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’ve been thinking a lot about EHR software and the part it plays in the hospital IT ecosystem. The $36 billion of EHR stimulus money has shined a big light on EHR software. No doubt the EHR incentive money has increased EHR adoption, but at what cost. I wonder if the EHR incentive money has caused many hospital IT teams to place undue emphasis on the EHR software.

The reality of a hospital IT ecosystem is that they usually have hundreds of healthcare IT systems in their organization. The EHR is just one of those systems. In fact, it might not even be the largest system. Their ERP system (usually Peoplesoft or SAP in large hospitals) could be larger. However, try being system #90 at a hospital. Do you think the IT people at a large hospital system are paying much attention to what’s happening to that system? Not only are they distracted chasing the EHR incentive money, but even without that incentive there are 89 other systems in front of it.

I’m reminded of this Healthcare CIO Mindmap that I posted previously. It’s a great image of the amazing complexity that a healthcare CIO is facing. Each of the branches on that mindmap represent one or more IT systems that have to be managed by an organization. That’s a complex and challenging task.

I guess my message here is that while the EHR is extremely important to an organization, don’t lose track of all the other healthcare IT systems you support. They won’t likely be noticed in the short term, but transgressing these smaller health IT systems will create organizational debt that will be hard to overcome in the future.

Over-hyped and Under-Delivered Tech According to Hospital CIOs

Posted on March 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This is an interesting list:
#BigData
#EHR
#Cloud
#GoogleGlass
#ACO

When you think about the future of health IT, all of these except for Google Glass are guaranteed to be a major role in health IT. The use of data in healthcare is not going anywhere. EHRs will be the foundation of health IT for a long time to come. The move to cloud computing is happening everywhere in healthcare. ACOs are heading are way and I see nothing that will do anything to stop them. Google glass is the only thing on the list that might fizzle, but what Google glass represents (always on, always connected computing) won’t go anywhere.

Does health IT have a PR image issue?

iOS App For Hospitals Snares $20M In VC Funding

Posted on January 10, 2013 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 we’ve reported previously, nurses are as fond of mobile technology as doctors, with large numbers bringing their own devices in for day-to-day communication at work. Maybe that’s why a new app — dubbed “Yammer for hospital staffers” by GigaOm — is getting so much money and attention.

The app, PatientTouch for the iPod Touch, has already been rolled out to 65 hospitals across the country, GigaOm reports. And today, maker PatientSafe announced that it had received $20M in funding for Merck. That brings its total amount raised to an eye-popping $50 million. That’s gotta be some kind of record for health apps, even in the red-hot clinical communication app space.

As GigaOm describes it, PatientTouch’s core functions allow nurses to collect basic  It’s also offering souped-up communications. Not only does it offer Yammer-like person to person chat, that chat also can be integrated directly into EMRs. (The story doesn’t say exactly how this wonderfulness happens, or whether, say, it works with a leader like Epic or Cerner or Meditech.)

But that’s not all. PatientTouch also comes with a “jacket” for the Touch which protects it from unsanitary conditions and fluids, preserves battery life, and more intriguingly, includes a bar-code scanner.

The understandably proud CEO of PatientSafety, Joe Condurso, told GigaOm that on any given day, 7,000 PatientSafe-equipped Touches are in use.

I can see why the VCs and Merck are so excited by PatientTouch. It’s based on a very cheap yet powerful platform, offers (what I’ll assume is) secure communication between providers without the BYOD mess and integrates with EMRs, yet. What’s not to like?

All that being said, I can’t see a solution like this one as more than a bridge. Sure, it’s great that it’s helping nurses communicate via a better channel than random BYOD-driven text and e-mail until EMR makers create their own mobile front ends. But personally, I hope the need for a transitional solution like this doesn’t last long.  It’s long overdue for the big EMR vendors to create robust mobile front ends of their own that integrate directly into their platform. Enough foot dragging, already!

The Cloud and Hospitals

Posted on November 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Guest Post: How Can Health IT Help with Hospital Customer Service

Posted on August 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Ron Troy. Ron Troy is a MBA, IT professional, and someone who has spent far too much time in hospitals for not actually working in them (since his teens)!

One of the topics in the ONC based HealthIT training I’m currently going through is Customer Service.

It’s arguable that customer service in a hospital setting is a bad joke with some exceptions. Hospitals are all about processing as many patients as possible with as little in the way of resources as possible to keep down costs while maximizing revenues. Patients don’t so much pick a hospital as an emergency or a doctor picks one for them, and hospital management and staff know that.

Consider the ER experience from a patient view point. Assuming you didn’t come by ambulance and are not having a heart attack or profusely bleeding, a triage nurse takes some info and tells you to sit – if you can find one of the worn out uncomfortable seats. I did this once for several hours with a hot, painful appendix! Eventually someone calls you over for your insurance info, and you then go back to find your seat gone. So, you are in pain, uncomfortable, maybe bleeding (but not too bad); eventually you will get called in and put on a hard as rock stretcher – probably on the side of a narrow hallway. Within just a few hours someone will take your vitals, a doctor will eventually show up, some tests will be done, and you finally get some treatment or told you will someday be admitted or taken to the OR. You are now desperately thirsty, hungry, and in more pain! And that’s just the ER!

Upstairs, rooms are noisy with alarms (EKG, IV pumps, etc.) that only patients seem to hear. You finally fall asleep only to be woken up for a sleeping pill or to get your BP taken. For the first few days you get food chosen by someone else – never what you want, you get your first menu to fill out when you are about to be discharged. Once in a while a doctor comes in to say hello, and later you discover you owe the guy hundreds for that hello!

I could go on, but this is hardly ‘customer service’. Or by the definition of a HealthIT lecture, a good example of poor service. You may get excellent health care, maybe your IV’s that are supposed to be continuous are not allowed to run out and maybe they don’t keep stopping, but you have only lousy memories of the experience.

Many years ago, I worked for a while as Assistant Director of Housekeeping at Doctor’s Hospital in Manhattan (now part of another hospital). You walk in the main lobby and you think you are in a luxury hotel. It is very quiet and calm – one could refinish the floor there mid day and not cause a problem (but you would never do so). The floors themselves are also very calm and quiet. The basic food is good, but you can order actual room service quality food (complete with tux clad waiter) if you want. Patient care is very good, and when you want to sleep at night, odds are you will be in a quiet room in a good hospital bed. You won’t pick up any new bug – the place is way too clean for that.

I don’t expect all that in today’s hospitals, but they could sure learn something about how patients get better faster when calm and quiet and comfortable and decently fed! HealthIT can assist in that – especially when hospital IT gear is inter connected. EKG monitors, IV pumps, blood oxygen sensors and the like popping up flags on the nursing station big monitors and nurses’ pads or laptops instead of alarms shrieking all over the place. A new patient arrives, gets handed a pad (if they are up to it) to note meal preferences, desire for TV and phone. It can even take their credit cards to pay for the extras. Better yet, a touch screen TV / terminal at each bed- press the ‘call nurse’ button and someone pops up on screen (and they can see you and talk to you) and you tell them in a low, plain voice what’s wrong. Then the right person can come to help. And if you really want to push the envelope, that screen can have a button to press that will show you what tests, doctors visits and more you are scheduled for, and about when! Nice – you can tell prospective visitors what your EXPECTED schedule is! And you might even let your patient see a view of test results (and when the doctor will be available to discuss them).

The point being; customer service in hospitals can be good, and can even make the hospital more cost effective! It can even help the patient to be part of the healing process. And HealthIT can be a part of that – though a customer service attitude would really help too!

Most Industries Trend Away from Building Software to Buying Software

Posted on July 30, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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 got the following repsonse to my post about whether to build or buy hospital health IT software:

I think it’s worth comparing to other industries. In most cases those industries slowly move away from building IT to buying IT. What happens is companies get more and more specialized and more and more flexible with their configurations that it’s cheaper to just buy the solution and customize the solution. There’s still cost to customize, but it’s cheaper than building it from scratch. Although, many are then disappointed that it’s not everything they want.

I have to agree that this is the case and is a great description to the overall trend that happens in companies. In many cases the companies start building their IT. Then, over time more and more IT is bought instead of being built. Little by little your IT team consists of customizers and project managers instead of programmers and database developers. Once this switch occurs, it’s really hard to go back to building your IT.

Do you see the same thing happening in hospital IT?

Is EMR Interoperability A Pipe Dream?

Posted on January 28, 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.

In theory, interoperability between vendors offers the vendors some rewards.  In particular, by making in possible for customers to link up between their own and their competitors’ systems, they broaden the market substantially, as customers aren’t afraid of getting locked into a single solution.  Also, in theory interoperable systems are stronger than isolated sandboxes, as they share data in a way which benefits customers.

Unfortunately, though, the EMR market defies the usual logic of the enterprise software business, so much so that I doubt  we’ll see this generation of vendors even try to interoperate with their competitors:

Larger vendors have little incentive to connect:  The market’s leading vendors already have enough market share (it seems) that they can roll out a product based on proprietary technology and get healthcare CIOs to swallow it.  Some may even buy the logic of people like Epic CEO Judith Faulkner, who’s argued that adopting products from only one vendor is safer and more efficient.

Healthcare organizations are extraordinarily risk-averse:  Anytime an organization invests big bucks in software, EMR or not, they’re pretty damned careful that they’re getting it right.  In this case, that means going with the vendorvwhich has managed to win the heart of the C-suite. (In reality, that means that if they fail they fail spectacularly, across the board, but that’s a tale for another day.)

Open source alternatives aren’t much of a factor:  In theory, if open source alternatives were getting some footing, healthcare CIOs’ attitude might be different. Not only the technology but the culture of open source development would pretty much rule out creating a proprietary island around their EMRs.  But at present, the “big iron” vendors (such as Epic, Cerner and Meditech) are far, far ahead.

Standards are still malleable:  In theory, we have HL7, but it can be correctly implemented and still incompatible with other implementations.  Not sure how we’re going to fix that, but it’s definitely a major barrier to implementation all of its own.

HIEs are all over the map:  Maybe, just maybe, if an HIE vendor had a staggeringly large share of the market, EMR vendors would be forced to step to its tune and at least interoperate with that vendor’s technology, which could help things a great deal. But as things stand, to my knowledge, no one HIE player has been able to pull this off.

Now, if cloud-based EMRs grow more popular, there’s new possibilities for interconnectivity, but it probably won’t help the interoperability problem. Honestly, I doubt we’ll see much progress here until a new generation of EMR vendors is born. What do you think?

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.

Why Hospitals Can’t Talk EMRs With Doctors

Posted on September 1, 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.

To me, the following truths are self-evident.

* Hospitals will never have the same priorities as doctors. So, any EMR that works well for doctors probably won’t fit too well into the hospital view of things.

* EMRs that help doctors offer higher-quality care won’t do much to improve a hospital’s bottom line. Why?  Hospitals are designed to deal with the results of poor outcomes (if not poor care).

* Hospitals really don’t care whether an EMR is designed well; their goal is to amass and manage data warehouses, not make doctors’ lives easier.

Not only that, hospitals and doctors have dramatically different ways of using EMR systems.

For hospitals, EMRs are a tool for managing flow — patients, rooms, medications, nurses, you name it.

While no one working there wants to think of patients that way, logistically they’re the key product on a factory floor.  Think of a car manufacturing assembly line.  Bring all the humanity you want to the process, IT managers still need to make that factory hum, today.

For doctors, EMRs are about personal effectiveness — a tool for managing and documenting a highly individualized process. Obviously, medical practices need to keep the “line” moving and patients coming in and out, but their unit of delivery is still one patient at a time.

A doctor’s EMR needs to capture their idiosyncrasies and make it easy to find the data they need. If they’re really lucky, medical practices will figure out how to use EMRs to improve care, but over weeks, months or even years. They can’t do that unless the tools they use are flexible, capable of fine-grained views of individual patient data and pretty easy to use.

Now, you tell me. Sure, doctors and hospitals are partners — and maybe some will create Accountable Care Organizations that catch fire — but will they ever reconcile their differing IT needs?  I say, probably not.

And that means that sharing an EMR will always be painful, fractured experience that doesn’t really meet either side’s needs.

Of course, there is one health data solution that could bring everyone onto the same page — an HIE!  Sharing the data makes MUCH more sense than trying to share an application, right? But for reasons I suspect you all know already, I wouldn’t hold my breath waiting for those spring up everywhere. It’s a real shame.

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.