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Patients Accessing Online Medical Records Use More Services

In previous postings, I’ve noted that for various reasons, doctors using EMRs are tending to bill for more E/M services.  This has CMS in a bit of a tizzy, and definitely deserves attention from the industry. (See also this post about EMR and Upcoding)

Now, a study appearing in the Journal of the American Medical Association seems to have identified another vector for increased use of services. According to the study, patients with online access to medical records and clinicians consume more clinical services than those without access.

The JAMA authors drew this conclusion after studying the consumption of clinical services by members of Kaiser Permanente Colorado, a group model IDS.  The Kaiser unit was studied from March 2005 through June 2010, reports Becker’s Hospital Report. 

What made the Kaiser unit a good choice was that not only did it have an EMR in place, it also launched a patient portal in May 2006 allowing patients secure access to health records details such as test results, care plans and active medications.

Researchers found that members who used the MyHealthManager portal, which gave access to the EMR, had increased rates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters and hospitalizations during the study period.

I was surprised to find out that JAMA researchers generated this data, especially the ED and hospitalization rates, which seem to have to been markedly different between the two groups.

It did occur to me that perhaps the sickest patients are using the portal, or that those who aren’t using the portal aren’t very engaged in caring for their health, but such relationships are rarely that simple. Besides, the researchers did group patients by “propensity scores” which took patient age, sex, utilization frequencies and chronic illnesses, so we aren’t looking at populations that simply self-selected into the sicker and more healthy.

In any event, I’m glad I stumbled across this study and could share it with you. Knowing that these patterns exist, just in case they turn up in your health system. They’re certainly worth bearing in mind.

November 29, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Epic or Best-of-Breed? The Billion-Dollar Question

Ah, the Judy Faulkner stories. They’re beginning to be as numerous, and, uh, epic as those of Microsoft and Apple’s early days.  Imagine the average-looking, middle-aged Faulkner — Epic’s CEO, of course — walking into a room of hospital CIOs and telling them she’d come “to decide who she wanted as customers.”  Kinda makes you want to admire Faulkner even if you don’t.

But more importantly, such behavior brings up the question of whether Epic brings enough to the table to make such grandstanding tolerable.  As Zina Moukheiber, a Forbes contributor, notes in a recent article, Epic has certainly convinced a lot of CIOs that the answer is yes, largely because it offers a single ecosystem hospitals can deploy across the enterprise.

But like myself, Moukheiber seems very skeptical that Epic has justified its astronomical prices, which include:

* Partners HealthCare and Duke University Health System, $700 million each
* University of California, San Francisco, $150 million
* Dartmouth-Hitchcock Medical Center, $80 million

I’d also drop in a casual mention of Kaiser Permanente’s Epic installation, which allegedly hit $4 billion-ish before it was done.

Of course, the issue isn’t merely whether Epic is expensive, but whether it gets the job done in a way which can’t be done by less expensive systems.  That, clearly, is the billion-dollar question.

In response, Moukheiber notes that in a recent New England Journal of Medicine piece, published earlier this month, two Boston Children’s Hospital Physicians argue that “diverse functionality needn’t reside within single EHR systems.”  Children’s uses Cerner, Epic and best of breed software as needed.

Yes, that’s  the heart of the matter, isn’t it. If you believe that there’s less risk and more chance of success implementing one system — thinking embraced by many hospital boards — Epic is likely to be a smash.

But if you’re a best-of-breed CIO, you’re probably astonished that anyone trusts their whole enterprise to a single vendor. Honestly, I am too.

June 27, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

How To Sell Your EMR To Patients

Today, I visited a mid-sized suburban hospital on some routine business.  Before leaving, I stopped and had lunch at the cafeteria, then tossed the trash into the barrel and stashed  the tray. Then, between the barrels, I noted a small sign — clearly designed for consumers – assuring them that EpicCare had arrived and that they should be, well, psyched.

The sign, lodged between the garbage barrels, said something to the effect of “Get well faster with EpicCare.”  I stared for a moment, incredulous. Did the otherwise sharp people running this hospital think this was going to encourage staff members OR patients to get excited about their Epic investment?

If I were running that hospital, here’s what I’d do to convince patients that the EMR offered an attractive  benefits:

*  Hand out fliers to every patient who entered the emergency department or inquired at the Information Desk outlining the reasons EMRs are going to make their lives easier and care safer

*  Offer a kiosk in key areas displaying a (simplified, attractive) version of the the EMR that people can experiment with which will help them become more comfortable with the idea

* Make sure your hospital’s home page offers videos of real doctors, nurses and other caregivers explaining how the EMR has changed their life for the better

* Hand out bookmarks, pressure balls, pens or other corporate toys with the URL for a site offering patients access to your patient portal.  Remind them verbally that the portal is there too. And why not put up a banner?

When Kaiser Permanente launched the PHR side of its overall EHR implementation, it used all of these tricks and more. Now, multiple millions of patients use the PHR (and EMR underlying it) to schedule appointments, look up lab results, check their history and more.

Without a big sell like this, your hospital is missing out big time on the PR benefits of making the big spend on EMRs. Worse, you’re missing out on the chance to get patients excited about what you’re doing.  Don’t waste that chance!

 

February 29, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Hospital EMR Failure Stories Very Hard To Find

Last week, my colleague Katherine Rourke wrote a post on how one hospital ended up junking its $50 million EMR after it turned out doctors wouldn’t use it.  You seemed to be quite interested; the post drew more traffic than virtually any piece we’ve posted since we launched this blog.

I would have loved to follow up with more case studies on hospital EMR failures, but I simply couldn’t find any, other than hints on health IT news and gossip site HIStalk.com. From Web searches alone, you’d think all EMRs rollouts were joyful walks in the park.

I guess I shouldn’t be surprised. After all, nobody wants to publicize when they’ve blown their budget on technology that doesn’t cut it.  And vendors obviously don’t want to publicize this kind of result, so they’re unlikely to spill the beans.  But it’s a real shame. After all, few industries improve their game if they don’t share worst practices along with the best.

The closest I came to insights on EMR failure was a postmortem, from 2010, on why the Department of Defense’s $2 billion, 13-year EMR implementation didn’t work.  According to to the GAO, the project finally faltered because of poor planning, poor execution and a failure by leaders to grasp just how complex their program was.

One might also cite the extremely painful and drawn-out process Kaiser Permanente went through in rolling out its Epic EMR, which was famously slammed in public, to 100,000+ employees, by a frustrated low-level employee.  While not a “failure” as such — in truth, these days Kaiser seems to be making great use of its investment — the project was rumored to have cost the company a tidy $4 billion or so, piled on top of hundreds of millions it had already spent on a failed home-grown system.

Honestly, everyone who reads this probably has a pretty good idea of why EMR projects fail.  Generally speaking, it seems to boil down to a few key mistakes such as:

*  The health system or hospital didn’t get realistic input from doctors, or disregarded such input, and so failed to realize that their clinicians would be miserable
*  The institution couldn’t mount the system quickly or efficiently enough to satisfy users, causing problems that demanded a new approach
*  IT leaders didn’t realize how big cost overruns would be for support, interfaces or other long-term development needs

But generalities only go so far. In truth, I’d argue that most hospital IT leaders get far, far too little feedback on why specific EMR projects failed.  And so they miss red flags that might have saved their organization a ton of money and grief.  Like I said, it’s a shame.

January 7, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Why Do People Dislike Epic So Much? Let Me Count The Ways

Man oh man, Epic is burning up the track. As my colleague John Lynn noted in a recent post, there are tons of reasons why it’s developed a near monopoly in some sectors, especially with large hospitals.

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 (as of 2008), Lynn notes.

And there’s tons of reasons Epic is doing so well (facts courtesy of @DanMunro) including:

* 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.”
* 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).
* 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.
* 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.

But is that all there is to the story? I don’t think such complaints are enough to generate the resentment, heck, hatred you pick up out there sometimes regarding the EMR giant.

It can’t help that many users dislike the Epic interface and generally find the product to be a PITA to use.  That doesn’t exactly generate good will.

The capper, really, may be the way Epic is handling its clout. CEO Judith Faulkner seems to be taking on an imperial attitude, doubtless because her company controls so many installations that it practically controls aspects of the entire US health reform process.

If you think that’s scary, consider the following. About six years ago, Geisinger Health System spent $35 million on an Epic Systems install. Not only after, during a pilot test of the software, the hospital’s psychiatric unit started to get wildly inconsistent and inappropriate medication orders. Apparently, the problem was an incompatibility between a commonly-used pharmacy database in place at Geisinger and the Epic system.

OK, just about any system can fail, and unfortunately, drug dosage problems are one of the many possible points of failure. That’s not what frightens me.

What had me reeling was a quote from a Business Week article written not long after the Geisinger debacle. When questioned, Faulkner didn’t apologize: she said, in essence, that it was Geisinger that was at fault for having the temerity to try and integrate Epic technology with existing systems. “It doesn’t work when you mix and match vendors,” Faulker told the magazine. “It has to be one system, or it can be dangerous for patients.”

Bear in mind that this was several years ago. I can only imagine that Faulker’s attitude has hardened since then, as her company’s market share and power has grown.  Will her position — that using best-of-breed, integrated health IT products is a bad idea — push the entire industry in that direction?  Perish the thought.

And that, my friends, is reason enough alone to reject Epic and all of its works, if you have the option.  At minimum, a healthy dislike seems very much in order. But maybe I’m being too harsh. What do you think?

August 21, 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.

How One Doctor Adapted To His Hospital’s Epic EMR Install

Here’s some words on coping with new hospital EMR installs — and the Epic Systems EMR in particular — from the pen of the thoughtful Dr. Bryan Vartabedian, who blogs at 33Charts.com.

Dr. Vartabedian, a pediatric gastroenterologist, works at Texas Children’s Hospital/Baylor College of Medicine. Apparently, Texas Children’s has just transitioned inpatient medical records to Epic, and Dr. Vartabedian is hard at work figuring out how to adjust his workflow.

How is it going for him? Dr. Vartabedian compares moving from paper to digital charting to his learning experiences as a medical student:

When I was a medical student…I was preoccupied with the mechanics of the exam and history.  Head to toe skin exam, cranial nerves, DTRs.  It was about pocket eye charts and tuning forks.  I was focused on my H&P at the expense of my connection.  It was only after I became familiar with the whole process did I relax and begin to focus eye-to-eye on the issues of the patient. 

Today, he’s going through a similar adjustment process, Dr. Vartabedian says. At first, he notes, he was obsessed with clicks and pulldowns, data and documentation, but he believes he’ll come out of his tech trance over time. “I suspect that as I customize the flow of how I work in Epic I’ll reemerge to connect eye-to-eye with residents, nurses and patients,” Dr. Vartabedian writes.

In an interesting side note, a fellow physician who’s been using Kaiser’s Epic system dropped by to comment that he’s had the same experience.  ”Dermdoc” said that he typically uses the EMR just before he enters the patient room. He only ends up using it during the patient visit if he has something to research, and he shares what he finds directly with the patient.

Dermdoc seems completely sold on his EMR — and seems convinced that his colleagues will inevitably get on board. “Like the Model T, there’s no going back,” he says.

 

July 27, 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.