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Hospital Using AI To Handle Some Tasks Usually Done By Doctors And Nurses

Posted on May 30, 2018 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.

One of the UK’s biggest facilities has announced plans to delegate some tasks usually performed by doctors and nurses to AI technology. Leaders there say these activities can range from diagnosing cancer to triaging patients.

University College London Hospitals (UCLH) has signed up for a three-year partnership with the Allen Turing Institute designed to bring machine learning to bear on care, a project which could ultimately spark additional AI projects across the entire National Health Service. The NHS is the body which governs all healthcare in the UK’s universal health system.

UCLH is making a big bet on artificial intelligence, investing what UK newspaper The Guardian describes as a “substantial” sum to develop the infrastructure for the effort.

UCLH officials believe — like other health organizations around the world — that machine learning algorithms may someday diagnose disease, identify people at risk for serious illness and more. Examples of related projects abound. Just one case in point is a project begun in 2016 by New York-based Mount Sinai Hospital, which launched an effort using AI to predict which patients might develop congestive heart failure and offer better care to those who have already done so.

Professor Bryan Williams, director of research at University College London Hospitals NHS Foundation Trust, said the move will be a “game changer” which could have a major impact on patient outcomes. “On the NHS, we are nowhere near sophisticated enough,” Williams told The Guardian. “We’re still sending letters out, which is extraordinary.”

UCLH’s first AI effort, which is already underway, is intended to identify patients likely to miss appointments. Using existing data, including demographic factors such as age and address plus outside factors like weather conditions, researchers there have been able to predict with 85% accuracy whether the patient will show up for outpatient visits and MRIs.

Another planned project includes improving the performance of the hospital’s emergency department, which, like many NHS hospitals, isn’t meeting government performance targets such as maximum four-hour wait times. “[This is] an indicator of some of the other things in the entire chain concerning the flow of acute patients in and out of the hospital,” UCLH chief executive Professor Marcel Levi told the newspaper.

The hospital envisions solving its wait-time problem with machine learning. Drawing on data taken from thousands of patients, machine learning algorithm might be able to determine whether a patient with abdominal pain suffers from severe problem like intestinal perforation or a systemic infection, then fast-track those patients. This kind of triage is generally performed by nurses in hospitals around the world.

That being said, the partners agree that machine learning performance must be incredibly accurate before it has any major role in care. At that point, it will be ready to support clinicians, not undercut them. According to Professor Chris Holmes of The Alan Turing Institute, the whole idea is to let doctors do what they do best: “We want to take out the more mundane stuff that’s purely information driven and allow time for things the human expert is best at.”

Despite EMR, Revenue Cycle Management Costs Were Still Substantial

Posted on April 26, 2018 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.

While they may not say so out loud, most healthcare organizations bought EMRs largely because they believed they could use them to lower revenue cycle management expenses. If so, they may be somewhat disappointed. A new study has concluded that at least in one case, the presence of a certified EMR didn’t make much of a dent in these costs.

­To conduct the study, researchers conducted interviews with 27 health system administrators and 34 physicians at a large academic medical center. The interviews took place in 2016 and 2017. The research team used the feedback to create a process map charting the path of an insurance claim through the RCM process.

Using this data, the researchers calculated the cost of each major billing and insurance-related activity, as well as a total cost of processing a claim from end to end. The data included costs for five types of patient encounters, including primary care visits, discharge ED visits, general medicine inpatient stays, ambulatory surgical procedures and inpatient surgical procedures.

The team concluded that estimated processing times and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged ED visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure and 100 minutes and $215.10 for an inpatient surgical procedure.

To put these numbers in perspective, the research team noted that billing costs represented an estimated 14.5% of professional revenue for primary care visits, 25.2% for emergency department visits, 8% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures and 3.1% for inpatient surgical procedures.

There are more than a few unfortunate things to be seen in these numbers.

One is that primary care practices spent a very high percentage of revenue on RCM, which could be crushing given their typically low margins. Given that PCPs are already being squeezed by patients who can’t afford to meet their high deductibles, this is a recipe for financial disaster.

It’s also troubling to see that that the academic medical center in question was spending more than 25% of its ED revenue chasing insurance payments. I found myself wondering whether ED prices might drop to a reasonable level if it was easier for these departments to collect from insurers.

It’s scary to think that these numbers might’ve been higher before the academic medical center installed its EMR. As things stand, if the EMR is lowering RCM costs, it doesn’t seem to be having a major impact. But I’m just guessing here — what do you think?

Hospital Patient Identification Still A Major Problem

Posted on April 18, 2018 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.

A new survey suggests that problems with duplicate patient records and patient identification are still costing hospitals a tremendous amount of money.

The survey, which was conducted by Black Book Research, collected responses from 1,392 health technology managers using enterprise master patient index technology. Researchers asked them what gaps, challenges and successes they’d seen in patient identification processes from Q3 2017 to Q1 2018.

Survey respondents reported that 33% of denied claims were due to inaccurate patient identification. Ultimately, inaccurate patient identification cost an average hospital $1.5 million last year. It also concluded that the average cost of duplicate records was $1,950 per patient per inpatient stay and more than $800 per ED visit.

In addition, researchers found that hospitals with over 150 beds took an average of more than 5 months to clean up their data. This included process improvements focused on data validity checking, normalization and data cleansing.

Having the right tools in place seemed to help. Hospitals said that before they rolled out enterprise master patient index solutions, an average of 18% of their records were duplicates, and that match rates when sharing data with other organizations averaged 24%.

Meanwhile, hospitals with EMPI support in place since 2016 reported that patient records were identified correctly during 93% of registrations and 85% of externally shared records among non-networked provider.

Not surprisingly, though, this research doesn’t tell the whole story. While using EMPI tools makes sense, the healthcare industry should hardly stop there, according to Gartner Group analyst Wes Rishel.

“We simply need innovators that have the vision to apply proven identity matching to the healthcare industry – as well as the gumption and stubbornness necessary to thrive in a crowded and often slow-moving healthcare IT market,” he wrote.

Wishel argues that to improve patient matching, it’s time to start cross-correlating demographic data from patients with demographic data from third-party sources, such as public records, credit agencies or telephone companies, what makes this data particularly helpful is that it includes not just current and correct attributes for person, but also out-of-date and incorrect attributes like previous addresses, maiden names and typos.

Ultimately, these “referential matching” approaches will significantly outperform existing probabilistic models, Wishel argues.

It’s really shocking that so many healthcare organizations don’t have an EMPI solution in place. This is especially true as cloud EMPI has made EMPI solutions available to organizations of all sizes. EMPI is needed for the financial reasons mentioned above, but also from a patient care and patient safety perspective as well.

Mayo Clinic Creating Souped-Up Extension Of MyChart

Posted on March 19, 2018 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 you probably know, MyChart is Epic’s patient portal. As portals go, it’s serviceable, but it’s a pretty basic tool. I’ve used it, and I’ve been underwhelmed by what its standard offering can do.

Apparently, though, it has more potential than I thought. Mayo Clinic is working with Epic to offer a souped-up version of MyChart that offers a wide range of additional services to patients.

The new version integrates Epic’s MyChart Virtual Care – a telemedicine tool – with the standard MyChart mobile app and portal. In doing so, it’s following the steps of many other health systems, including Henry Ford Health System, Allegheny Health Network and Lakeland Health.

However, Mayo is going well beyond telemedicine. In addition to offering access to standard data such as test results, it’s going to use MyChart to deliver care plans and patient-facing content. The care plans will integrate physician-vetted health information and patient education content.

The care plans, which also bring Mayo care teams into the mix, provide step-by-step directions and support. This support includes decision guidance which can include previsit, midtreatment and post-visit planning.

The app can also send care notifications and based on data provided by patients and connected devices, adapt the care plan dynamically. The care plan engine includes special content for conditions like asthma, type II diabetes chronic obstructive heart failure, orthopedic surgery and hip/knee joint replacement.

Not surprisingly, Mayo seems to be targeting high-risk patients in the hopes that the new tools can help them improve their chronic disease self-management. As with many other standard interventions related to population health, the idea here is to catch patients with small problems before the problems blossom into issues requiring emergency department visit or hospitalization.

This whole thing looks pretty neat. I do have a few questions, though. How does the care team work with the MyChart interface, and how does that affect its workflow? What type of data, specifically, triggers changes in the care plan, and does the data also include historical information from Mayo’s EMR? Does Mayo use AI technology to support care plan adaptions? Does the portal allow clinicians to track a patient’s progress, or is Mayo assuming that if patients get high high-quality educational materials and personalized care plan that the results will just come?

Regardless, it’s good to see a health system taking a more aggressive approach than simply presenting patient health data via a portal and hoping that this information will motivate the patient to better manage their health. This seems like a much more sophisticated option.

Yale New Haven Hospital Partners With Epic On Centralized Operations Center

Posted on February 5, 2018 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.

Info, info, all around, and not a place to manage it all. That’s the dilemma faced by most hospitals as they work to leverage the massive data stores they’re accumulating in their health IT systems.

Yale New Haven Hospital’s solution to the problem is to create a centralized operations center which connects the right people to real-time data analytics. Its Capacity Command Center (nifty alliteration, folks!) was created by YNHH, Epic and the YNHH Clinical Redesign Initiative.

The Command Center project comes five years into YNHH’s long-term High Reliability project, which is designed to prepare the institution for future challenges. These efforts are focused not only on care quality and patient safety but also managing what YNHH says are the highest patient volumes in Connecticut. Its statement also notes that with transfers from other hospitals increasing, the hospital is seeing a growth in patient acuity, which is obviously another challenge it must address.

The Capacity Command Center’s functions are fairly straightforward, though they have to have been a beast to develop.

On the one hand, the Center offers technology which sorts through the flood of operational data generated by and stored in its Epic system, generating dashboards which change in real time and drive process changes. These dashboards present real-time metrics such as bed capacity, delays for procedures and tests and ambulatory utilization, which are made available on Center screens as well as within Epic.

In addition, YNHH has brought representatives from all of the relevant operational areas into a single physical location, including bed management, the Emergency Department, nursing staffing, environmental services and patient transport. Not only is this a good approach overall, it’s particularly helpful when patient admissions levels climb precipitously, the hospital notes.

This model is already having a positive impact on the care process, according to YNHH’s statement. For example, it notes, infection prevention staffers can now identify all patients with Foley catheters and review their charts. With this knowledge in hand, these staffers can discuss whether the patient is ready to have the catheter removed and avoid related urinary tract infections associated with prolonged use.

I don’t know about you, but I was excited to read about this initiative. It sounds like YNHH is doing exactly what it should do to get more out of patient data. For example, I was glad to read that the dashboard offered real-time analytics options rather than one-off projections from old data. Bringing key operational players together in one place makes great sense as well.

Of course, not all hospitals will have the resources to pull something off something like this. YNHH is a 1,541-bed giant which had the cash to take on a command center project. Few community hospitals would have the staff or money to make such a thing happen. Still, it’s good to see somebody at the cutting edge.

Washington Hospitals Sue Over Cruel and Unusual Medicaid ED Visit Limits

Posted on October 17, 2011 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.

I’ve heard of some draconian budget-cutting measures, but the following, proposed by officials in Washington state, just about takes the cake. Good to see that the state’s hospitals, along with its doctors, are rightfully attempting to slam the door shut onMedicaid planners’ obscene antics.

A new state plan in Washington proposes to limit payment for Medicaid patients’ emergency department visits, on the extremely dubious assumption that such patients can self-diagnose whether they ought to be there in the first place. Not only is this program unlikely to save any real money (unless you count the money saved by not having to care for dead beneficiaries), it assumes that emergency department staffers are adding useless layers of expertise so often that their services should be choked back dramatically. The truth is, there’s boatloads of evidence that the poor aren’t the biggest users of ED services for non-emergent conditions, but I suppose these state penny-pinches wouldn’t be bothered by the facts.

Get this. The state’s Medicaid folks want to cover only three “non-emergency” visits per year — enough of a disincentive to prevent people from going in the first place — but it doesn’t end there. The plan would classify more than  700 diagnoses as “non-emergent,” including (wait for it) chest pain, abdominal pain and breathing problems.  So, I take it that pregnant women, infants, children, the disabled and the mentally ill are supposed to decide with a home thermometer and a bit of prayer whether they’re actually in danger?

According to the folks suing the state, which include the state medical association, hospital association and chapter of the American College of Emergency Physicians, this program not only endangers patients, but also has thrown a cloud of smoke around payment issues. Specifically, the plaintiffs argue that the state is threatening patients that they’ll be billed directly, while EMTALA and state charity care laws prohibit patient billing.

Folks, if I were a hospital executive, I’d be suing to avoid legal and political messes that will arise here, sure. But I’d be sick to my gut about what such rules would mean to real people, too. I truly hope that’s what the suing hospitals have in mind.

Hospital EMR actually works

Posted on June 4, 2011 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 some of you may know — if you read the EMRandEHR.com blog — I recently had an experience which set a fine example as to how much health IT can help hospitals when deployed well and supported by smart training. In short, a family member just had an effective, focused trip through a hugely busy ED, largely due, I believe to the technology it uses.

The hospital has deployed the Picis electronic document management system, along, seemingly, with traffic control modules, to strip much of the fat away from a patient’s trip through the ED.

With staff clicking away happily, patients moving in and out promptly and physicians having easy access to patient histories, med lists test results and more in one easy-to-access place, I saw a pretty neat ballet in place.

The truth is, however, that this seems to be an exception rather than the rule. Far more  hospitals I’ve visited seem to have taken a heavy-handed, training-light approach to introducing their EMR.  (One facility had installed screensavers on staff desktops that read “Cerner is coming.” I can’t imagine this gave any employees a big thrill, or helped them get prepared.)

Actually, when I passed through the same facility later, I saw flustered-looking nurses trying desperately to get simple transactions done, forming an insecure cluster together as they tried to help a colleague enter some observations. Thaaaat didn’t give me a nice, secure feeling about the hospital’s odds of making clinical mistakes.

I hate to say this, but I think the odds of a hospital IT department changing its culture enough to truly support EMR users is pretty darned small. My guess is that it will take several years before hospitals have a clue as to how to handle the big, huge change management process their EMR produces. Good luck, guys.

 

There’s no good excuse for stifling physician-owned hospitals

Posted on April 28, 2011 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.

When health reform was passed, part of the law forbid physician-owned hospitals from expanding or undertaking new construction.  The rules affected roughly 300 hospitals in 34 states, offering services ranging from acute care, women’s, rehabilitation and psychiatric care.

You won’t be surprised to hear that the trade group representing such hospitals, Physician Hospitals of America, continues to fight for removal of this restriction, found in section 6001 of the Patient Protection and Affordable Care Act.

I’ve got to say I’m with the PHA on this one. Why on earth must we block the development of physician-owned hospitals?  Yes, there have been a couple of horror stories where specialty physician-owned hospitals –lacking an emergency department — failed to address patient needs.

But from where I sit, those stories are no more common, proportionately, than they are amongst traditional acute care hospitals. Besides, if the main concern legislators had was emergency department care, they could have mandated that all physician-owned facilities have one.

No, it’s clear that physician-owned hospitals make traditionally-structured facilities nervous, and that they’ve worked hard to put them in their place.  Other than protecting the profit stream for themselves, however, I don’t think they have a leg to stand on.

 

 

Google takes over hospital industry, CMS in private leveraged buyout

Posted on April 18, 2011 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.

Read the headline?  Those are things that just aren’t going to happen, right?

Well, I’m pretty sure the things that we can expect for the next few years will end up looking just about that strange when we read about them a decade later.

My personal faves are a) Accountable care organizations dominate U.S. healthcare system, b) Most hospitals are connected to doctors via EMR and c)  Emergency departments no longer swamped with uninsured patients.

Anyone else want to volunteer “future headlines” — stuff that might come true but seems impossible at the moment? Or stuff that should happen but just can’t?  Sarcastic or serious, your choice.

So, you got your crystal ball out?  I’ll publish all of your predictions, crazy or not. 🙂

Bigger, better, faster hospitals are a great idea

Posted on December 13, 2010 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.

Nagoya City University Hospital in Kawasumi

Image via Wikipedia

The other day, I read a tweet from the estimable Matthew Holt in which he summarized what hospitals have been telling him.  In short, they seem to want bigger, badder, newer facilities.  In fact, if I recall correctly, they feel they’re in deep mud if they don’t get these  upgrades and/or new facilities soon.

OK, usually I take such statements with a grain or two of salt. After all, who  — in any industry — doesn’t want the latest and greatest, from the toys we squabble over on up into adulthood?  But in this case, I think we should be taking Holt’s feedback quite seriously.

After all, despite the fact that I’m not an architect, hospital CEO, designer  or any variation on same, I can immediately think of a few very important reasons for a massive buildout of hospitals to improve care and meet today’s process standards:

*  Shared rooms are right out.  There are already a fair number of hospitals (no stats to hand but this IS happening) who are converting all shared rooms to single rooms within their facility.  Their main rationale is infection control, but I think they’re also hoping to streamline the care process by allowing nurses to think rationally, about one patient a time.

*  Older physical plants are a huge liability. When you’ve got a house full of sick people, the last thing you want is a drip from that 20 year old pipe, asbestos to remediate, mold in ancient ducts and so on.  While maintenance will be an issue for any facility, we’ve learned a lot since the first wave of current hospitals were built. Let’s get rid of ’em ASAP.

*  If you’ve ever owned a house from the 70s (and I have) you know that they leak air conditioning and heat out at a ferocious rate.  Sure, you can weatherstrip and insulate and hang curtains to seal out air from the windows, but eventually, it starts to cost so much that it’s a big waste.  A new place — or hospital — is much cheaper over the long run.

*  And while they’re at it, hospitals newly-designed hospitals can be planned with green energy usage in mind — a trick which might not work out in a clumsy plant from decades a ago.  That not only helps to save the earth, it can save big bucks too.  Again, I don’t have a case study handy but Google “green hospitals” and  you’ll find some heartening stories.

* Oh, and I almost forgot…old hospitals can be a nightmare for techs to work around.  Whether you’re talking about simply making sure Wi-Fi gets to every corner of the building or rolling out an EMR, nobody needs to live with design flaws from the 60s.

So, though I’m surprised to say it, it seems to me that bigger, better, faster hospitals are indeed what the doctor ordered.  We’re not talking self-glorifying projects approved by boards to prove they’ve got the juice to make it happen, we’re talking simply about getting with the times.   Let’s hope plenty of hospitals find the means to do so.