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How Do You See Emerging Tech Like AI and Machine Learning Improving Efficiency in Clinical Settings?

Posted on April 12, 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.

The title of this post was the question that Samsung Healthcare posted to me:

Here was my knee jerk response:

At least a couple people strongly agreed including this one:

AJ is right that the tech is nearly there to do all of this. I suggested that they key is going to be the person that packages it the right way.

This is a lesson we all learned from the iPhone. Very few things within the iPhone were unique and new. It was how Apple packaged all of the components that made it special. I think it’s going to play out the same when it comes to physician documentation. All of the NLP, Voice Recognition, Machine Learning, and AI tools are out there. Everyone will have access to them, but how they’re packaged is going to make all the difference.

All of that said, I don’t see this too far off. We’re already starting to see elements of it, but the entrenched players will have a hard time doing this. They’re already getting rich off of their existing products, so they’ll continue to make incremental improvements. Some startup company is going to come along and package this all the right way and win.

Plus, let’s be clear that one of the biggest parts of the packaging will be how it transitions users from the old way of thinking to a new approach. However, once the doctor sees it in action, they’ll see it as magical. Compared to the forms they’re doing today, it will be magical.

Who do you see offering this? Are any of the EHR vendors brave enough to do this? It’s so badly needed by so many.

Health Leaders Go Beyond EHRs To Tackle Value-Based Care

Posted on March 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.

In the broadest sense, EHRs were built to manage patient populations — but largely one patient at a time. As a result, it’s little wonder that they aren’t offering much support for value-based care as is, as a recent report from Sage Growth Partners suggests.

Sage spoke with 100 healthcare executives to find out what they saw as their value-based care capabilities and obstacles. Participants included leaders from a wide range of entities, including an ACO, several large physician practices and a midsize integrated delivery network.

The overall sense Sage seems to have gotten from its research was that while value-based care contracts are beginning to pay off, health execs are finding it difficult support these contacts using the EHRs they have in place. While their EHRs can produce quality reports, most don’t offer data aggregation and analytics, risk stratification, care coordination or tools to foster patient and clinician engagement, the report notes.

To get the capabilities they need for value-based contracting, health organizations are layering population health management solutions on top of their EHRs. Though these additional PHM tools may not be fully mature, health executives told Sage that there already seeing a return on such investments.

This is not necessarily because these organizations aren’t comfortable with their existing EHR. The Sage study found that 65% of respondents were somewhat or highly unlikely to replace their EHR in the next three years.

However, roughly half of the 70% of providers who had EHRs for at least three years also have third-party PHM tools in place as well. Also, 64% of providers said that EHRs haven’t delivered many important value-based contracting tools.

Meanwhile, 60% to 75% of respondents are seeking value-based care solutions outside their EHR platform. And they are liking the results. Forty-six percent of the roughly three-quarters of respondents who were seeing ROI with value-based care felt that their third-party population PHM solution was essential to their success.

Despite their concerns, healthcare organizations may not feel impelled to invest in value-based care tools immediately. Right now, just 5% of respondents said that value-based care accounted for over 50% of their revenues, while 62% said that such contracts represented just 0 to 10% of their revenues. Arguably, while the growth in value-based contracting is continuing apace, it may not be at a tipping point just yet.

Still, traditional EHR vendors may need to do a better job of supporting value-based contracting (not that they’re not trying). The situation may change, but in the near term, health executives are going elsewhere when they look at building their value-based contracting capabilities. It’s hard to predict how this will turn out, but if I were an enterprise EHR vendor, I’d take competition with population health management specialist vendors very seriously.

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.

E-Patient Update:  Patients And Families Need Reassurance During EMR Rollouts

Posted on March 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.

Sure, EMR rollouts are stressful for hospital staffers and clinicians. No matter how well you plan, there will still be some gritted teeth and slammed keyboards as they get used to the new system. Some will afraid that they can’t get their job done right and live in fear of making a clinical mistake. All that said, if your rollout is gradual and careful, and your training process is thorough, it’s likely everyone will adjust to the new platform quickly.

The thing is, these preparations leave out two very important groups: patients and their families. What’s more, the problem is widespread. As a chronically ill patient, I visit more hospitals than most people, and I’ve never seen any effective communication that educates patients about the role of the EMR in their care. I particularly remember one otherwise excellent hospital that decorated its walls with asinine posters reading “Epic is here!” I can’t see how that could possibly help staff members make the transition, much less patients and family members.

This has got to change. Hospital IT will always be evolving, but when patients are swept up in and confused by these changes, it distorts everything that’s important in healthcare.

Needless fear

A recent experience my mother had exemplifies this problem. She has been keeping watch over my brother Joseph, who is critically ill with the flu and in an induced coma. For the first few days, as my brother gradually improved, my mother felt very satisfied with the way the clinical staff was handling his case.

Not long after, however, someone informed her that the hospital’s new Epic system was being deployed that day. Apparently, nobody explained what that really meant for her or my brother, and she felt that the ICU nurses and doctors were moving a bit more slowly during the first day or two of the launch. I wasn’t there, but I suspect that she was right.

Of course, if things go well, over the long run the Epic system will fade into the background and have no importance to patients and their families. But that day or two when the rollout came and staff seemed a bit preoccupied, it scared the heck out of her.

Keeping patients in the loop

Don’t get me wrong: I understand why this hospital didn’t do more to educate and reassure my mother. I suspect administrators wouldn’t know how to go about it, and probably feel they don’t they have time to do it. The idea is foreign. After all, communicating with patients about enterprise health IT certainly isn’t standard operating procedure.

But isn’t it time to involve patients in the game? I’m not just talking about consumer-facing technology, but any technology that could reasonably affect their experience and sense of comfort with the care they’re receiving.

Yes, educating patients and families about enterprise IT changes that affect them is probably out of most health IT leaders’ comfort zones. But truthfully, that’s no excuse for inaction. Launching an Epic system isn’t inside-baseball process — it affects everyone who visits the hospital. Come on, folks, let’s get this right.

Recent Acquisitions are Changing the Healthcare Software Landscape

Posted on February 26, 2018 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

Customers of many software solution have been nervously watching their solutions change hands, leading to increased concerns about the future of those products. Most recently, Allscripts surprised the industry first with the acquisition of Mckesson’s software solutions and now with the purchase of Practice Fusion. Last year, Hyland purchased the Perceptive and Brainware software products from Kofax, and now has purchased Mckesson OneContent from Allscripts. What do these changes mean for the industry and how should owners of these products react to their critical solutions changing hands?

Mergers and acquisitions are nothing new to the software industry. Epic, with its policy of developing entirely in-house and not acquiring other solutions, is the exception, not the rule. For most software companies, acquiring mature solutions to expand into a new market or to acquire customers is a standard method of growth. However, the recent rapid-fire acquisitions in the EHR and document imaging spaces have surprised many customers of those products.

McKesson announced the sunset of their Horizon clinical products years ago, positioning Paragon as its replacement. Yet that is only one of their package of solutions which includes OneContent for document imaging, STAR for billing, Relay Health for claims, Pathways for ERP, and others, many of which are all in use together at some hospitals. When Mckesson sold out its products to Allscripts, many questions came up about the future of those products.

When that deal was done, Allscripts gave the first hint of the product future by announcing that Mckesson Paragon would be their solution for smaller hospitals. That suggested the focus would be on Allscripts, not Paragon, as their go-forward solution. Now with the sale of OneContent to Hyland, Allscripts appears to be divesting itself of some of the Mckesson solutions. Others may soon follow.

Perceptive software was sold to Lexmark many years ago, which in turn acquired Kofax and then the solution was sold to its largest competitor, Hyland. Hyland, which is the developer of the Onbase product, now has purchased OneContent, and now has the customers of three large providers of document imaging solutions all under one roof.

How long will it make sense for them to continue to enhance three different competing solutions? While support may last for many years, there will be limitations to what they will enhance in these older solutions to avoid dividing up R&D resources and creating market confusion.

Allscripts now has a large number of older Mckesson solutions that it will have to evaluate and determine their future. While Practice Fusion may serve as a solution for smaller clinics who would not be candidates for Allscripts, Mckesson’s Paragon product is a direct competitor to Allscripts. Other solutions such as Pathways may simply not be worth further investment and may be outside of Allscript’s core mission.

Hospitals that currently have any solutions whose future is in doubt should start to evaluate their options and consider what is in their long-term interest. Each vendor will likely offer attractive paths to transition to their preferred solution, and it may be best to take advantage of those options early to give sufficient time to make the change.

Change is never easy. The employees of these organizations are going through significant change as are the users of these solutions. However, healthcare technology leaders should always be looking ahead to what’s next and be prepared for change – for change is the only thing that we are guaranteed.

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.

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.

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.

Merged Health Systems Face Major EHR Integration Issues

Posted on January 2, 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.

Pity the IT departments of Advocate Health Care and Aurora Health Care. When the two health systems complete their merger, IT leaders face a lengthy integration process cutting across systems from three different EHR vendors or a forklift upgrade of at least one.

It’s tough enough to integrate different instances of systems from the same vendor, which, despite the common origin are often configured in significantly different ways. In this case, the task is exponentially more difficult. According to Fierce Healthcare, when the two organizations come together, they’ll have to integrate Aurora’s Epic EHR with the Cerner and Allscripts systems used by Advocate.

As part of his research, the reporter asked an Aurora spokesperson whether health systems attempt to pull together three platforms into a single EHR. Of course, as we know, that is unlikely to ever happen. While full interoperability is obviously an elusive thing, getting some decent data flow between two affiliated organizations is probably far more realistic.

Instead, depending on what happens, the new CIO might or might not decide to migrate all three EHRs onto one from a single vendor. While this could turn out to be a hellish job, it certainly is the ideal situation if you can afford to get there. However, that doesn’t mean it’s always the best option. Especially as health system mergers and acquisitions get bigger and bigger.

To me, however, the big question around all of this is how much the two organizations would spend to bring the same platforms to everyone. As we know, acquiring and rolling out Epic for even one health system is fiendishly expensive, to the point where some have been forced to report losses or have had ratings on the bond reduced.

My guess is that the leaders of the two organizations are counting often-cited merger benefits such as organizational synergies, improved efficiency and staff attrition to meet the cost of health IT investments like these. If this academic studies prove this will work, please feel free to slap me with a dead fish, but as for now I doubt it will happen.

No, to me this offers an object lesson in how mergers in the health IT-centered world can be more costly, take longer to achieve, and possibly have a negative impact on patient care if things aren’t done right (which often seems to be the case).

Given the other pressures health systems face, I doubt these new expenses will hold them back from striking merger deals. Generally speaking, most health systems face little choice but to partner and merge as they can. But there’s no point minimizing how much complexity and expense EHRs bring to such agreements today.

Hospital Takes Step Forward Using Patient-Reported Outcome Data

Posted on December 6, 2017 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 don’t usually summarize stories from other publications — I don’t want to bore you! — and I like to offer you a surprise or two. This time, though, I thought you might want to hear about an interesting piece appearing in Modern Healthcare. This item offers some insight into how understanding patient-generated determinants of health could improve outcomes.

The story tells the tale of the Hospital for Special Surgery, an orthopedics provider in New York City which provides elective procedures to treat joint pain and discomfort. According to the MH editor, HSS has begun collecting data on patient-reported outcomes after procedures to see not only how much pain may remain, but also how their quality of life is post-procedure.

This project began by doing a check in with the patient before the procedure, during which nurses went over important information and answered any questions the patient might have. (As readers may know, this is a fairly standard approach to pre-surgical patient communication, so this was something of a warm-up.)

However, things got more interesting a few months later. For its next step, the hospital also began surveying the patients on their state of mind and health prior to the procedure, asking 10 questions drawn from the Patient-Reported Outcomes Measurement Information System, or Promis.

The questions captured not only direct medical concerns such as pain intensity and sleep patterns, but also looked at the patient’s social support system, information few hospitals capture in a formal way at present.

All of the information gathered is being collected and entered into the patient’s electronic health record. After the procedure, the hospital has worked to see that the patients fill out the Promis survey, which it makes available using Epic’s MyChart portal.

Getting to this point wasn’t easy, as IT leaders struggled to integrate the results of the Promis survey into patient EHRs. However, once the work was done, the care team was able to view information across patients, which certainly has the potential to help them improve processes and outcomes over time.

Now, the biggest challenge for HSS is collecting data after the patients leave the hospital. Since kicking off the project in April, HSS has collected 24,000 patient responses to nursing questions, but only 15% of the responses came from patients who submitted them after their procedure. The hospital has seen some success in capturing post-surgical results when doctors push patients to fill out the survey after their care, but overall, the post-surgical response rate has remained low to date.

Regardless, once the hospital improves its methods for collecting post-surgical patient responses, it seems likely that the data will prove useful and important. I hope to see other hospitals take this approach.