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Are You Still Doing the Happy Dance for Your EHR?

Posted on February 16, 2018 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.

Today I stumbled upon this video from 6 years ago with Flagler Hospital celebrating the implementation and launch of the Allscripts EMR in their organization. Here’s the video in case you’ve never seen it:

We’ve written previously about the value of these videos bringing the team at your hospital together. Any big project such as an EHR implementation is a challenging thing and it’s important to get your whole team involved and to have some fun in the process.

At the end of the video they hold up a sign that says Good Bye Paper. 6 years later, I wonder how they feel about this video and their EHR implementation. Would they still be doing the happy dance? Could they make another video celebrating their EHR?

I know a few organizations where they could. They’ve implemented the EHR effectively and are happy with how it works. Sure, they still have things they’d like changed, updated, modified, etc. However, they’re generally happy to be on an EHR over paper charts. Plus, there’s a whole generation of doctors now that don’t know the paper charts world and know no difference.

Unfortunately, there are many other hospitals that are cursing their EHR software. They might do a video about their EHR, but it would be a satire video about the challenges they still face using an EHR.

Where are you at with your EHR? Are you doing a happy dance or are you disappointed, frustrated, or upset with having to use an EHR in your hospital? Share your thoughts in the comments.

Pilot Effort Improves EHR Documentation

Posted on February 9, 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.

Though EHRs were intended to improve medical documentation, in many cases they seem to have made documentation quality worse. Despite their best intentions, bogged-down physicians may resort to practices — notably excessive copy-and-paste usage — that turn patient records into bloated, unfocused data masses that don’t help their peers much.

However, a pilot program conducted by a group of academic medical centers suggests using a set of best practice guidelines and templates for progress notes can improve note quality dramatically. The pilot involved intern physicians on inpatient internal medicine rotations at UCLA, the University of California San Francisco, the University of California San Diego and the University of Iowa.

According to a related story in HealthData Management, researchers rated the quality of the notes created by the participating interns using a competency questionnaire, a general impression score and the validated Physician Documentation Quality Instrument 9-item version (PDQI-9).

The researchers behind the study, which was published in the Journal of Hospital Medicine, found that the interns’ documentation quality improved substantially over the course of the pilot. “Significant improvements were seen in the general impression score, all domains of the PDQI-9, and multiple competency items, including documentation of only relevant data, discussion of a discharge plan, and being concise while adequately complete,” the authors reported. Even better, researchers said notes generated by the participating interns had about 25% fewer lines and were signed 1.3 hours earlier in the day on average.

One side note: despite the encouragement provided by the pilot, the extent to which interns used templates varied dramatically between institutions. For example, 92% of interns at UCSF used the templates, compared to 90% at UCLA, 79% at Iowa and only 21% at UCSD. Nonetheless, UCSD intern notes still seemed to improve during the study period, the research report concluded. (All four institutions were using an Epic EHR.)

It’s hard to tell how generalizable these results are. After all, it’s one thing to try and train interns in a certain manner, and another entirely to try and bring experienced clinicians into the fold. It’s just common sense that physicians in training are more likely to absorb guidance on how they should document care than active clinicians with existing habits in place. And unfortunately, to make a real dent in documentation improvement we’ll need to bring those experienced clinicians on board with schemes such as this.

Regardless, it’s certainly a good idea to look at ways to standardize documentation improvement. Let’s hope more research and experimentation in this area is underway.

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.

Apple Trials Tech Offering Patient Access To Their Health Records

Posted on January 29, 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.

In recent times, tech giants have been falling over themselves in a race to offer consumers the best access to their health data, including even dark horses like Amazon. And it’s little wonder – it’s become increasingly obvious that he who controls patient health data access controls a critical sector of the entire healthcare industry.

The most recent stake in the ground comes from Apple, whose latest update to its Health app allows customers to see their medical records on their iPhone. The Health Records section of the Health app, which comes with the release of the iOS 11.3 beta, collects FHIR-based records from multiple sources and makes them available through its Health Records section.

The patient data display will pull together patient data from various healthcare organizations into a single view. The data will include lists of allergies, conditions and medications taken, immunizations records, lab results on procedures and vital sign information. When providers published new information, iPhone users will be notified.

To conduct its Health Records beta test, Apple has partnered with a number of high-profile health systems and hospitals, including Johns Hopkins Medicine; Cedars-Sinai; Penn Medicine; Geisinger Health System; UC San Diego Health; UNC Health Care; Rush University Medical Center; Dignity Health; Ochsner Health System; MedStar Health and OhioHealth.

As part of its launch, Apple told the New York Times that unless consumers specifically choose to share it with the company, it will never see the data, which will be encrypted and stored locally on the iPhone.  A recent (if unscientific) poll suggests that consumers trust Apple with their health data more than other top tech vendors, so this reassurance may be enough to ease their fears.

But security is hardly Apple’s biggest concern. How does the tech colossus expect to profit from its health data investments?  When I break the issues down, it looks like this:

  • Unlike hospitals and clinics, which can expect medium- to long-term ROI when patients manage their health better, Apple doesn’t deliver care.
  • Apple might want to sell anonymized aggregated patient data, but as far as I know, the company would still have to get patient permission, and that would be an administrative and legal nightmare.
  • If Apple or its competitors have some vision of selling access to the patient, good luck with that. Providers have a hard time attracting and keeping patients with nifty technology even if those patients live in their backyard.

While I could be missing something major, from what I see, Apple, Google, Samsung, Amazon and the rest are engaging in a series of preemptive patient data land grabs. My sense is that none of them know exactly what to do with this data, they’ll be damned if they’re going to let their competitors get there first.

That said, many in the industry are suggesting that this move is just another effort by Apple to sell more iPhones. The question I ask is how valuable will the information be to the patients? Certainly the beta hospitals and health systems are large and have a lot of data, but how is this going to scale down to the smaller providers? If you don’t have these smaller providers, then you’re going to be missing some of the most important health data.

Deep Learning System Triages Terminally Ill Hospital Patients

Posted on January 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.

Researchers at Stanford have developed a new tool designed to coordinate end-of-life care for critically ill patients. While the pilot study has generated screaming newspaper headlines (“AI tool predicts when people will die!”) researchers say that the system is best thought of as a triage option which helps hospitals and hospices provide timely palliative care to those who need it. It can also help terminally ill patients — most of whom would prefer to die at home — make plans for their passing and avoid dying in their hospital bed.

According to an article in tech publication Gizmodo, the Stanford set-up combines EHR data with other sources of information such disease type, disease state and severity of admission. The information is then processed by a form of AI known as deep learning, in which a neural network “learns” by digesting large amounts of data.

To conduct the study, researchers fed 2 million records from adult and child patients admitted to either Stanford Hospital or Lucile Packard Children’s Hospital. The system then identified 200,000 patients who met the study’s criteria. In addition to clinical criteria, the system also reviewed associated case reports diagnoses, number of scans ordered, number of procedures performed and other data.

After reviewing 160,000 case reports, the deep learning system was instructed to predict the mortality of a given patient within three to 12 months of a particular date using EHR data from the previous year. The algorithm included a requirement to ignore patients who appeared to have less than three months to live, as this window was too short for providers to make preparations to offer palliative care.

Then, the AI algorithm calculated the odds of patient death in the 3 to 12-month timespan extending from the original date. Its predictions turned out to be quite accurate. For one thing, it predicted patient mortality within the 3 to 12-month window accurately in nine out of 10 cases, a performance that few clinicians could match. Meanwhile, roughly 95% of patients considered to have a low probability of dying within 12 months actually lived beyond that point.

It’s worth noting that while the deep learning tool made fairly accurate predictions of patient mortality, the system doesn’t let healthcare providers know what treatment patients need or even how it makes its predictions. Luckily, researchers say, the system allows them to get a look at individual cases to better understand its deductions.

For example, in one case the system predicted accurately that a patient with bladder and prostate cancer would die within a few months. While there were many clues that he was near death, the system weighted the fact the scans were made of his spine and a catheter used in his spinal cord heavily in its calculations. Only later did the researchers realize that an MRI of the spinal cord most likely suggested a deadly cancer of the spinal cord which was likely to metastasize.

It’s worth remembering these results were produced as part of a pilot project, and that the predictions the system makes might not be as accurate for other data sets. However, these results are an intriguing reminder of the possibilities AI offers for hospitals.

An EHR Vendor’s Efforts to Address Physician Burnout with Corinne Proctor Boudreau from MEDITECH

Posted on January 24, 2018 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.

Physician burnout is a major problem in healthcare. While there are a lot of things that are contributing to physician burnout, many like to point to the EHR as a major reason why so many physicians are getting burnt out. So, while the EHR can’t completely solve physician burnout, a well designed EHR can help to alleviate some of the stress a physician experiences.

With this idea in mind, we jumped at the chance to sit down with Corinne Proctor Boudreau, Senior Manager, Physician Experience at MEDITECH, to learn about what MEDITECH is hearing from their customers about physician burnout and what they’ve been doing and plan to do to alleviate this challenging problem.

Check out our full physician burnout interview with Corinne Proctor Boudreau embedded below or on YouTube.

You can find all of Healthcare Scene’s interviews on the Healthcare Scene YouTube channel. Also, at the start of the video, I mentioned our new conference, Health IT Expo happening at the end of May in New Orleans. We hope you’ll all be able to join us in New Orleans to learn about practical innovations that can benefit your organization.

Texas Hospital Association Dashboard Offers Risk, Cost Data

Posted on January 22, 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.

The Texas Hospital Association has agreed to a joint venture with health IT vendor IllumiCare to roll out a new tool for physicians. The new dashboard offers an unusual but powerful mix of risk data and real-time cost information.

According to THA, physician orders represent 87% of hospital expenses, but most know little about the cost of items they order. The new dashboard, Smart Ribbon, gives doctors information on treatment costs and risk of patient harm at the point of care. THA’s assumption is that the data will cause them to order fewer and less costly tests and meds, the group says.

To my mind, the tool sounds neat. IllumiCare’s Smart Ribbon technology doesn’t need to be integrated with the hospital’s EMR. Instead, it works with existing HL-7 feeds and piggybacks onto existing user authorization schemes. In other words, it eliminates the need for creating costly interfaces to EMR data. The dashboard includes patient identification, a timer if the patient is on observational status, a tool for looking up costs and tabs providing wholesale costs for meds, labs and radiology. It also estimates iatrogenic risks resulting from physician decisions.

Unlike some clinical tools I’ve seen, Smart Ribbon doesn’t generate alerts or alarms, which makes it a different beast than many other clinical decision support tools. That doesn’t mean tools that do generate alerts are bad, but that feature does set it apart from others.

We’ve covered many other tools designed to support physicians, and as you’d probably guess, those technologies come in all sizes. For example, last year contributor Andy Oram wrote about a different type of dashboard, PeraHealth, a surveillance system targeting at-risk patients in hospitals.

PeraHealth identifies at-risk patients through analytics and displays them on a dashboard that doctors and nurses can pull up, including trends over several shifts. Its analytical processes pull in nursing assessments in addition to vital signs and other standard data sets. This approach sounds promising.

Ultimately, though, dashboard vendors are still figuring out what physicians need, and it’s hard to tell whether their market will stay alive. In fact, according to one take from Kalorama Information, this year technologies like dashboarding, blockchain and even advanced big data analytics will be integrated into EMRs.

As for me, I think Kalorama’s prediction is too aggressive. While I agree that many freestanding tools will be integrated into the EMR, I don’t think it will happen this or even next year. In the meantime, there’s certainly a place for creating dashboards that accommodate physician workflow and aren’t too intrusive. For the time being, they aren’t going away.

Roche, GE Project Brings New Spin To Clinical Decision Support

Posted on January 10, 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.

The clinical decision support market is certainly crowded, and what’s more, CDS solutions vary in some important ways. On the other hand, one could be forgiven for feeling like they all look the same. Sorting out these technologies is not a job for the faint of heart.

That being said, it’s possible that the following partnership might offer something distinctive. Pharmaceutical giant Roche has signed a long-term partnership deal with GE Healthcare to jointly develop and market clinical decision support technology.

In a prepared statement, the two companies said they were developing a digital platform with a difference. The platform will use analytics to fuel workflow tools and apps and support clinical decisions. The platform will integrate a wide range of data, including patient records, medical best practices and recent research outcomes.

At least at the outset of their project, Roche and GE Healthcare are targeting oncology and critical care. With a pharmaceutical company and healthcare technology firm working together, providing tools for oncology specialists in particular makes a lot of sense.

The partners say that their product will give oncology care teams with multiple specialists a common data dashboard to review, which should help them collaborate on treatment decisions. Meanwhile, they plan to offer critical care physicians a dashboard integrating data from patient’ hospital monitoring equipment with their biomarker, genomic and sequencing data.

The idea of integrating new and possibly relevant information to the CDS platform is intriguing. It’s particularly interesting to imagine physicians leveraging genetic information to make real-time decisions. I think it’s safe to say that we’d all like it if CDS systems could bring the rudiments of precision medicine to thorny day-to-day clinical problems.

But the truth is, if my interactions with doctors mean anything, that few of them like CDS systems. Some have told me flat out that they end up overriding many CDS prompts, which arguably makes these very expensive systems almost irrelevant to hospital-based clinical practice. It’s hard to tell whether they would be willing to trust a new approach.

However, if GE and Roche can pull off what they’re pitching, it might just provide enough value it might convince them. Certainly, creating a more flexible dashboard which integrates data and office workflows is a large step in the right direction. And it’s probably fair to say that nothing like this exists in the market right now (as they claim).

Again, while there’s no guaranteed way to build out useful technology, bringing a pharma giant and a health IT giant might give both sides a leg up. I wonder how many users and patients they have involved in their design process. Let’s see if they can back up their promises.

Hospital Mobile Strategy Still In Flux

Posted on January 8, 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.

The following is a look at how hospitals’ use of communication devices has changed since 2011, and what the patterns are now.  You might be surprised to read some of these data points since in some cases they defy conventional wisdom.

The researchers behind the study, communications tech provider Spok, Inc. surveyed about 300 healthcare professionals this year, and have tracked such issues since 2011. The report captures data on the major transitions in hospital mobile communications that have taken place since then.

For example, the report noted that in 2011, 84% of staffers received job-related alerts on pagers. Sixty-two percent are using wireless in-house phones, 61% desk phones, 77% email on their computers, 44% cell phones and 5% other devices.

Since then, mobile device usage in hospitals has changed significantly. For example, 77% of respondents said that their hospital supports smartphone use. The popularity of some devices has come and gone over time, including tablets and Wi-Fi phones (which are nonetheless used by 63% of facilities).

Perhaps the reason this popularity has risen and fallen is that hospitals are still finding it tricky to support mobile devices. The issues include supporting needed infrastructure for Wi-Fi coverage (45%), managing cellular coverage infrastructure (30%), maintaining data security (31%) and offering IT support for users (about 30%). Only 11% of respondents said they were not facing any of these concerns at present.

When the researchers asked the survey panel which channels were best for sharing clinical information in a hospital, not all cited contemporary mobile devices. Yes, smartphones did get the highest reliability rating, at 3.66 out of five points, but pagers, including encrypted pagers, were in second place with a rating of 3.20. Overhead announcements came in third at 2.91 and EHR apps at 2.39.

The data on hospitals and BYOD policies seemed counterintuitive as well. According to Spok, 88% of facilities supported some form of BYOD in 2014, or in other words, roughly 9 out of 10.  That percentage has fallen drastically, however, BYOD support hitting 59% this year.

Not surprisingly, clinicians are getting the most leeway when it comes to using their own devices on campus. In 2017, 90% of respondents said they allowed their clinicians to bring their own devices with them. Another 69% supported BYOD for administrators, 57% for nurses and 56% for IT staffers. Clearly, hospital leaders aren’t thrilled about supporting mobility unless it keeps clinical staff aligned with the facility.

To control this cacophony of devices, 30% said they were using enterprise mobility management solutions, 40% said they were evaluating such solutions and 30% said they had no plans to do so. Apparently, despite some changes in the devices being used, hospitals still aren’t sure who should have mobile tools, how to support them and what infrastructure they need to keep those devices lit up and useful.

Hospitals Puts Off Patient Billing For Several Months During EMR Rollout

Posted on January 6, 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.

Here’s something you don’t see every day. A New Hampshire hospital apparently delayed mailing out roughly 10,000 patient bills going back as far as 11 months ago while it rolled out its new EMR.

According to a report in the Foster’s Daily Democrat,  members of Frisbie Memorial Hospital’s medical staff recently went public with concerns about the hospital’s financial state. Then a flood of delayed patient bills followed, some requesting thousands of dollars, the paper reported.

Hospital officials, for their part, said the delay was planned. Hospital president John Marzinzik said Frisbie needed time to implement its new Meditech EMR and didn’t want to send out incorrect bills during the rollout.

In fact, Marzinzik told Foster’s, under the previous system, records generated during doctor visits weren’t compatible with forms for hospital billing.

Rather than relying further on this patchwork of incompatible systems, Marzinzik and his staff decided to wait until the process was “absolutely clean” for patients. The hospital decided to have a staff member validate every balance shown on a statement before sending them out, he says.

Previously, in December of last year, anonymous Frisbie medical staff members sent Foster’s a letter to share concerns about the hospital and its administrators. The criticisms included skepticism about the over-budget implementation of the $13.5 million Meditech system, which they named as one of the reasons they lack confidence in the hospital administration. The staff members said that this cost overrun, as well as other problems, have undermined the hospital’s financial position.

As is always the case in such situations, hospital leaders took the stage to deny these allegations. Frisbie Senior VP Joe Shields told the paper that the hospital is in sound financial condition, and also said that the only reason why the Meditech project went over budget by $1.5 million was that the administrators delayed the implementation by seven weeks to give the staff holiday time off.

Hmmm. I don’t know about you, but to me, some parts of this story look a little bit bogus. For example:

* I appreciate accurate hospital bills as much as anybody, but the staff was going to check them manually anyway, why did it take 10 or 11 months for them to do so?

* The holidays take place at the same time every year.  Did administrators actually forget they were coming to an event that necessitated an almost 10% cost overrun?

Of course, only a small number of people know the answers to these questions, and I’m certainly not one of them. But the whole picture is a little bit odd.