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Paper to EMR is Much Easier to Justify Than EMR to EMR

Posted on May 30, 2013 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.

When I was last in DC at the Healthcare Forum, I heard hospital CIO Bill RiegerStep Out” and talk about some of the challenges he faces as a hospital CIO. One of the things he said in his talk really rang true to me and is going to become an increasingly important topic in healthcare.

His comment: The ROI from Paper to EMR is Much Easier to Justify than EMR to EMR

This is a powerful and challenging thing to consider. I’m sure those at Epic, Cerner, Meditech, etc are licking their chops knowing that it will take a hospital CIO with special leadership skills to overcome this challenge. Yes, from their perspective they have some incredible customer lock in. However, Bill went on to describe that it’s not impossible to lead such an effort. In fact, his hospital was switching EMR software shortly after I heard him speak.

The biggest challenge with this idea isn’t that there’s no ROI to switch from one EMR to another EMR. There can be a significant ROI, but most hospital CIOs are afraid to make such a call. They’re afraid to really dig in deeply to find out what a new EMR might mean for their hospitals. Sometimes this is because they were the one who implemented the first EMR. Other times it’s they’re too risk averse to take on such a challenging project. It’s often easier to sweep thing under the rug than it is to pull up the rug and really see what’s going on under the covers.

I’m of course not suggesting that switching EMR software is always the right decision either. One of the first lessons I learned out of college was that change doesn’t always mean better. In fact, a change can make things worse.

I do believe that continuous improvement leads to beautiful results. Too many in healthcare IT are satisfied with status quo. If we’re going to continuously improve, one area we can start is to dig deeply into the ROI of going from electronic to electronic.

Do We Need To Allow Hospitals To Donate EMRs?

Posted on May 28, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today I was looking through my Twitter inbox and found this complaint, by @lee_ritz:

EMR systems are putting private physician groups out of business–we can’t afford to compete with the big hospital groups.

Certainly, it’s hard to argue that some EMRs can put a big strain ( as much as $50K+ per doctor) on medical practices . And for those in low-margin specialties like primary care, perhaps that could be the death-blow financially. But are we at a point where we need to somehow pay for EMRs for small practices above and beyond Meaningful Use incentives?

One way to address this problem comes straight from the loving arms of the American Hospital Association.

Right now, the HHS Office of the Inspector General has proposed a rule which would extend the EMR safe harbor  — allowing hospitals to donate EMRs and health IT to practices and not face a kickback investigation — from the end of this year until December 31, 2106.  Looked at one way, that’s a pretty good offer, as it and gives both hospitals and medical practices the change to get those donated EMRs in place and situated while both sides iron out Meaningful Use issues.

The AHA is arguing that safe harbor protections should be made  permanent. Its executives argue that the safe harbor is a valuable tool for getting health IT into the hands of rural physicians; that with the donations, hospitals can provide the tech support, training and maintenance medical practices need to use EMRs properly; and that hospitals can donate EMRs to physicians across entire areas, ensuring interoperability.

The AHA also notes that not all providers are eligible for Meaningful Use incentives, and that new physicians, presumably needing hospital help to get their EMRs rolling, will begin to practice after the deadline has passed. And on top of all of this, the AHA letter to the OIG states, changes in interoperable technologies will require new donations going forward if doctors and hospitals are to stay connected.

Is this the solution to the problem of making sure cash-strapped smaller practices can afford to have powerful EMR technologies that connect with hospitals and peers?  It’s hard to say, but I do think there’s some merit to at least extending the protections further and keeping a close eye on what happens.

In this day and age, when getting EMRs into medical practices is such a key federal objective, it does seem to me that the hospitals deserve a generous turn at bat.  After all, the money has to some from somewhere.

Do Hospitals Care About Healthcare IT Accelerator Companies?

Posted on May 24, 2013 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 quite a bit about all the various Healthcare IT accelerators out there. There’s a lot of interest in investment in healthcare right now. Just today I posted about a new online healthcare investment portal called VentureHealth. Add in the Rock Health, Startup Health, NYeC Accelerator, Blueprint Health, and Healthbox (I’m sure I’m missing a few others) and we’re seeing a really tremendous interest in trying to create innovative solutions for healthcare.

Despite all this movement and investment, I’m afraid to ask, “Do hospitals care about Healthcare IT accelerator companies?”

In all the conversations I’ve had with hospital executives, I can’t remember once hearing them say that they can’t wait to see what innovations come out of a healthcare accelerator. Sure, some of the accelerators are more focused on consumer health, but there seems like a major disconnect between healthcare accelerators and actual hospitals and doctors.

I noted the one exception to this seemed to be the NYeC accelerator which seems to have good connections to a number of NY based hospitals. Now that their first class is complete, I’ll be interested to talk to those companies that participated to see how well those connections really played out.

To be honest, I’m not sure why there’s the disconnect. Are hospital CIO’s just overwhelmed with all the daily minutiae and government regulations that they don’t have time to look at innovations? Are the healthcare accelerator companies not producing something worthy of hospital CIO interest?

Regardless of why, I see a wide chasm between the innovations that are being worked on in healthcare accelerators and the actual healthcare decision makers.

Boston Children’s Creates Special Adolescent PHR

Posted on May 22, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Creating PHRs for adolescents is trickier than preparing them for adults. While childrens’ and adolescents’ PHRs are usually controlled by parents, there are some areas in which teens have a right to privacy, including any discussions about sexually transmitted diseases, reproductive health, substance abuse and mental health information.

At Boston Children’s Hospital, they’re grappling with the problem of a creating a PHR which protects the adolescent’s right to privacy and confidentiality of such information without sealing parents out of areas which are public. This is a difficult problem, given that confidential information is generally seeded throughout EMRs, writes the hospital’s Fabienne Bourgeois.

To address the complex problem of giving adolescents appropriate access to their PHRs, BCH has developed a custom-built portal to meet both hospital and adolescent patient needs, Bourgeios says.

Adolescent patients and parents access the portal separately, through linked accounts.  Parents have sole access until the child turns 13, at which point both get access. At 18  years, the patient becomes the sole owner of the portal account, and unless other constraints exist, the parent link is deactivated, she notes.

Within the portal, sensitive content has been identified and tagged, such as pregnancy-related labs, genetic results, confidential appointments, and possibly sensitive problems and medication.  Right now this data is filtered from both parent and adolescent accounts, but in the future it will flow only to the adolescent account. “This solution does take a lot of time and effort, but best replicates current clinical practice,” Bourgeious notes.

This is quite an interesting project. It’s good to see researchers taking on unique privacy challenges involved in treating adolescents.  Any efforts which engage a population in their own health and make them confident their privacy will be protected are to be commended.

Should EMRs Help Patients Retrieve Medical Records?

Posted on May 21, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As often as not, patients who need to retrieve paper medical records from hospitals go through a painful process, one which is not much easier than it was before EMRs were introduced in hospitals.

I found this out myself recently when I attempted to retrieve a medical record for one of my children from a large hospital in my metro area.  I started by reaching out to the health information management department — where it took three separate calls before I connected with a staff member.  Then I was informed that the despite the paper-free hospital environment, I would have to wait two weeks before I could lay hands on the medical record, as the staff was swamped.

This would have struck me as comical if it wasn’t such an unfortunate situation. Without HIEs in place universally across the hospital world, wouldn’t it make sense if the EMR helped produce the paper copies of records needed everywhere in a universal fashion?

Yes, I realize that EMRs are optimized for care during the hospital visit, and such is necessary to get the job done.  That being said, I could easily see using some of the technology hospitals already have in place to make EMR records retrievable by caregivers and patients.

After all, at least some hospitals already have kiosks in place that allow patients to pay bills. Couldn’t a modification of such kiosk allow patients to pay for their records fees, order the records for a given patient, sign electronically to give permission for such a printout and get the records into the mail on the back end — if not straight into their hands?

Sure, I know HIPAA issues arise when you’re trying to automate the dispensing of private health information, but at least until HIEs are everywhere, it’s a problem that needs to be handled.  After all, the reality is that patients need to carry print records all over the place to get decent care. What’s the point of urging patients to engage with their medical records data if simply retrieving hard copies of them is such an awkward chore?

I know there was some debate about this in meaningful use. Hopefully once the future stages of meaningful use are in place, getting your records from the EHR will be a much faster process than it is today.

Health IT Haiku

Posted on May 20, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Now for something completely different, folks. Here’s some haiku verses (5-7-5 syllable scheme) on EMR and HIT issues. I’m hoping y’all jump in and give it a try next.

EMR cutover
Could it be that all our work
Comes down to this day?

Everyone freaks out
EMR has gone off line
Painful nine seconds

Meaningful Use is
Years of pain and suffering
For a bite-sized check

Can’t write haiku on
interoperabili-
ty, or can you now?

Elegant, simple
EMR interface is
Rarer than diamonds

Fifty million spent
Putting in their EMR
Which they then threw out

Hospital EHR Subsidies

Posted on May 17, 2013 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.

In response to Anne’s post on Senator’s questioning the meaningful use EHR incentive money, Gary Colvin emailed me the following comment:

I would argue for the case where the only reason some providers are in the M.U. game is due to their Hospital subsidies. Instead of paying approx $1,200/ month to lease out their Epic E.M.R., they are enjoying its benefits for under $300 per month. What happens when the subsidy goes away for good? I think you would be hard pressed to see a four doc family practice paying $4,800 / month to enjoy that system — so, when the subsidy goes away (maybe it will be extended to 2016?) it will surely have an impact on who stays in the game.

I did question Gary on his algebra of the cost of Epic per doctor and he said that he got numbers from his hospital which is a public hospital where the pricing has to be transparent. It actually makes me wonder what other EHR pricing data could be uncovered from various publicly available sources. I wonder if data geek Fred Trotter has ever worked on this.

Regardless, I think the EHR subsidies is an important topic. I’ve known many doctors that are afraid of the hospital EHR subsidy because of the lock in it creates with the hospital. However, in many areas the lock in is already there so it doesn’t matter.

I wonder if hospitals are worried what it will mean for them once the EHR subsidies are no longer available.

Judy Calls Epic “Most Open System I Know”

Posted on May 16, 2013 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.

After Zina Moukheiber from Forbes was declined an interview with Judy Faulkner, CEO of Epic, last year Judy decided to talk to Zina about Epic in this article “An Interview With The Most Powerful Woman In Health Care.” Zina does a nice job on the interview and raises some of the questions many people have about Epic. It’s worth a read if you like to follow the hospital EHR world.

Many people are likely going to latch on to Zina calling Judy Faulkner the “most powerful woman in health care.” I don’t think that’s really up for discussion. Judy is the most powerful woman in healthcare and so I’m really glad that Judy is starting to join the discussion about Epic and healthcare. She has an important voice in the discussion and we need her participation. Although, I’m sure she’ll hate being called a billionaire in the article. The reality is we don’t know how much Judy’s really worth until we know how much Epic is worth and I’m not sure Epic plans to go public anytime soon.

Semantics aside, the most important part of the interview was the discussion of Epic being a closed system to which Judy frankly replied, “We are the most open system I know because we’re built as a database management system, and database management systems need to allow their users to mold it to what they need.” I think she really believes that Epic is an open system and quite frankly there aren’t that many in healthcare she can look to that are more open. Sure, a number of EHR vendors have worked to be more open, but even they aren’t as open as many other non health IT software systems. Maybe Judy hasn’t looked at the APIs outside of healthcare.

The real disconnect I had when reading Judy’s thoughts on being open is her lack of understanding of how a truly open API works. In a well implemented API, you can allow any and all programmers to be able to build applications on top of your software without those programmers needing to read your code and study your internal software. I’m not saying you don’t want and need to have an application and verification process for those people who want to tap into your API. This can be part of the process, but a well implemented and documented API can be open to everyone interested in building on top of your software. The value Epic would receive from so many companies iterating and extending the core Epic functionality would be amazing.

The other facet of Epic openness discussed in the article was around interoperability. Judy offered these comments on Epic’s ability to share patient records:

As of March 2013, our customers exchanged 760,000 patient records per month; about one-third were with non-Epic systems. Based on the historical trajectory, we expect that we’re closer to exchanging approximately one million records per month. We are currently exchanging data with Allscripts, Cerner, Department of Defense, Veteran Affairs Administration, Social Security Administration, eHealth Exchange (formerly Nationwide Health Information Network), Greenway, MEDITECH, NextGen and others. We expect to be exchanging data soon with eClinicalWorks, General Electric, Surescripts, and others.

This sounds good on face, but lets consider how many records Epic is sharing. Let’s use the round number of 1 million patient records shared per month. The article says that Epic has about half of the US population on Epic, or about 150 million patients. That means that about 0.67% of Epic’s patient records are being shared.

I’m happy to applaud Epic for sharing 1 million records a month with so many different vendors. My only complaint is that they could do so much more. For example, if you can share records between Epic and Cerner now, does that work for all Epic hospitals or do you have to do the new integration with every hospital that says they want to share records with Cerner? If it was a turn key way to integrate with Cerner, I’m quite sure that instead of 1% of Epic’s patient records being shared we’d see tens of millions of patient records flowing where they needed to go.

Many might remember my surprise breakfast with Judy Faulkner at the CHIME Forum. From my personal experience, Judy is not the black widow that I’ve heard many portray her to be. In fact, I found her incredibly thoughtful, caring, and really interested in quality patient care. That’s why I hope Judy will see that she’s sitting on an opportunity to do so much more than she’s doing now. Although, it will take a shift in her understanding of what it means to be an open EHR. Right now it seems her mostly unfounded fears won’t let her see the possibilities.

Epic Module Targets Patients For Care Coordination

Posted on May 15, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

At Gundersen Lutheran Health System, executives have put together a program to target the 1 to 2 percent of those most likely to be hospitalized, seen in the emergency department or face other complications. To manage the program, the La Crosse, Wis.-based system is leveraging a feature of their Epic EMR which sifts out the patients most in need of additional care coordination, reports Health Data Management.

Gundersen Lutheran is targeting complex patients with its program, but not just those with medically-complex conditions. They’re also hoping to find patients who, while they might have simpler conditions, live alone or have trouble following sometimes difficult medical care plans.  The system is using the EMR first to identify the patients, then to treat them, according to Health Data Management.

To find patients in need of extra care coordination services, Gundersen is using a “tiered scoring” module built in to the Epic platform which includes one component for medical complexity and another to measure psycho-social issues. When clinicians want to refer a patient to the care coordination program, physicians use the Epic scoring tool to see if  the patient qualifies. Clinicians can also notify the care coordination team using the Epic system, in three clicks or less, noted Beth Smith, R.N., executive director of patient and family-centered care at the health system.

The patients identified by the scoring model as in need of extra care coordination are farmed out to a group of 22 nurses and social workers, whose job it is to monitor the care of these complex patients who are more likely to face adverse events.

The workload the care coordinators face is intense.  Typically, care managers are supervising some 1,700 patients each, who not only stay in touch with patients but also attend office visits and follow through with specialists.  Epic plays a role here too, however.  Care coordinators get a special tab in the Epic EMR which pulls key elements of the patient’s history into a single view,  making it easier to get a sense of the whole patient.  Epic also notifies them via a message in the system if a patient shows up in the ED.

According to Health Data Management, this program has helped stabilize hypertensive and diabetic patients, with just under half showing sustained improvements over a two-year period.

Hospital Vs. Clinic EMRs: Key Differences

Posted on May 14, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In some ways, hospital and clinic EMRs have the same job to get done — to assess, test and treat patients. But they do have to be optimized differently, as hospitals and clinics do things at a different pace and of necessity are organized differently.

Here’s some of those differences, courtesy of TELUS Health’s Shawn Vincent:

*  Difference number one:  Minutes count

Hospitals care for patients in acute situations, where minutes or even seconds can determine the patient’s outcome.  In medical practices, “care is measured in weeks, not hours,” Vincent notes.

Result:  Hospitals need test results immediately, where clinic patients can wait until their next visit days or weeks later.

* Difference number two:  Patient departures

In hospitals, patients consume resources until discharge, and that doesn’t happen when tests and treatments are still outstanding.  In clinics, patients can leave while tests are outstanding or treatment results are still pending.

Result:  Hospitals must perform well at “round trip” test and treatment management.

* Difference number three: Who runs the show?

Hospitals are generally run by a large corps of professional leaders, including boards of directors, business expects, lawyers and many other stakeholders.  Medical practices, traditionally, owned by doctors who practice there, and are responsible for care, documentation, and ultimately, liability for all that takes place.

Result:  Hospitals usually have tough rules in place about how medicine can be practiced, and also how it is documented, which roll down to everything from how the EMR user interface looks to how events are audited. In clinics, doctors make their own rules.

* Difference number four: Short vs. long-Term Care

Hospital encounters usually call for just enough information to treat the patient — more can be a distraction which slows down care.  In medical practices, on the other hand,  having longitudinal data on the patient is central to caring for them over the years.

Result:  Hospital IT systems must be artfully designed to display “just enough information to make a meaningful medical decision without distracting the user with unnecessary details,” he notes.

Readers, what other differences between hospital and medical practice EMRs do you consider to be important?