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Healthcare Interoperability is Solved … But What Does That Really Mean? – #HITExpo Insights

Posted on June 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.

One of the best parts of the new community we created at the Health IT Expo conference is the way attendees at the conference and those in the broader healthcare IT community engage on Twitter using the #HITExpo hashtag before, during, and after the event.  It’s a treasure trove of insights, ideas, practical innovations, and amazing people.  Don’t forget that last part since social media platforms are great at connecting people even if they are usually in the news for other reasons.

A great example of some great knowledge sharing that happened on the #HITExpo hashtag came from Don Lee (@dflee30) who runs #HCBiz, a long time podcast which he recorded live from Health IT Expo.  After the event, Don offered his thoughts on what he thought was the most important conversation about “Solving Interoperability” that came from the conference.  You can read his thoughts on Twitter or we’ve compiled all 23 tweets for easy reading below (A Big Thanks to Thread Reader for making this easy).

As shared by Don Lee:

1/ Finally working through all my notes from the #HITExpo. The most important conversation to me was the one about “solving interoperability” with @RasuShrestha@PaulMBlack and @techguy.

2/ Rasu told the story of what UPMC accomplished using DBMotion. How it enabled the flow of data amongst the many hospitals, clinics and docs in their very large system. #hitexpo

3/ John challenged him a bit and said: it sounds like you’re saying that you’ve solved #interoperability. Is that what you’re telling us? #hitexpo

4/ Rasu explained in more detail that they had done the hard work of establishing syntactic interop amongst the various systems they dealt with (I.e. they can physically move the data from one system to another and put it in a proper place). #hitexpo

5/ He went on and explained how they had then done the hard work of establishing semantic interoperability amongst the many systems they deal with. That means now all the data could be moved, put in its proper place, AND they knew what it meant. #hitexpo

6/ Syntactic interop isn’t very useful in and of itself. You have data but it’s not mastered and not yet useable in analytics. #hitexpo

7/ Semantic interop is the mastering of the data in such a way that you are confident you can use it in analytics, ML, AI, etc. Now you can, say, find the most recent BP for a patient pop regardless of which EMR in your system it originated. And have confidence in it. #hitexpo

8/ Semantic interop is closely related to the concept of #DataFidelity that @BigDataCXO talks about. It’s the quality of data for a purpose. And it’s very hard work. #hitexpo

9/ In the end, @RasuShrestha’s answer was that UPMC had done all of that hard work and therefore had made huge strides in solving interop within their system. He said “I’m not flying the mission accomplished banner just yet”. #hitexpo

10/ Then @PaulMBlack – CEO at @Allscripts – said that @RasuShrestha was being modest and that they had in fact “Solved interoperability.”

I think he’s right and that’s what this tweet storm is about. Coincidentally, it’s a matter of semantics. #hitexpo

11/ I think Rasu dialed it back a bit because he knew that people would hear that and think it means something different. #hitexpo

12/ The overall industry conversation tends to be about ubiquitous, semantic interop where all data is available everywhere and everyone knows what it means. I believe Rasu was saying that they hadn’t achieved that. And that makes sense… because it’s impossible. #hitexpo

13/ @GraceCordovano asked the perfect question and I wish there had been a whole session dedicated to answering it: (paraphrasing) What’s the difference between your institutional definition of interop and what the patients are talking about? #hitexpo

14/ The answer to that question is the crux of our issue. The thing patients want and need is for everyone who cares for them to be on the same page. Interop is very relevant to that issue, obviously, but there’s a lot of friction and it goes way beyond tech. #hitexpo

15/ Also, despite common misconception, no other industry has solved this either. Sure, my credit card works in Europe and Asia and gets back to my bank in the US, but that’s just a use case. There is no ubiquitous semantic interop between JP Morgan Chase and HSBC.

16/ There are lots of use cases that work in healthcare too. E-Prescribing, claims processing and all the related HIPAA transactions, etc. #hitexpo

17/ Also worth noting… Canada has single payer system and they also don’t have clinical interoperability.

This is not a problem unique to healthcare nor the US. #hitexpo

18/ So healthcare needs to pick its use cases and do the hard work. That’s what Rasu described on stage. That’s what Paul was saying has been accomplished. They are both right. And you can do it too. #hitexpo

19/ So good news: #interoperability is solved in #healthcare.

Bad news: It’s a ton of work and everyone needs to do it.

More bad news: You have to keep doing it forever (it breaks, new partners, new sources, new data to care about, etc). #hitexpo

19/ Some day there will be patient mediated exchange that solves the patient side of the problem and does it in a way that works for everyone. Maybe on a #blockchain. Maybe something else. But it’s 10+ years away. #hitexpo

20/ In the meantime my recommendation to clinical orgs – support your regional #HIE. Even UPMC’s very good solution only works for data sources they know about. Your patients are getting care outside your system and in a growing # of clinical and community based settings. #hitexpo

21/ the regional #HIE is the only near-term solution that even remotely resembles semantic, ubiquitous #interoperability in #healthcare.
#hitexpo

22/ My recommendation to patients: You have to take matters into your own hands for now. Use consumer tools like Apple health records and even Dropbox like @ShahidNShah suggested in another #hitexpo session. Also, tell your clinicians to support and use the regional #HIE.

23/ So that got long. I’ll end it here. What do you think?

P.S. the #hitexpo was very good. You should check it out in 2019.

A big thank you to Don Lee for sharing these perspectives and diving in much deeper than we can do in 45 minutes on stage. This is what makes the Health IT Expo community special. People with deep understanding of a problem fleshing out the realities of the problem so we can better understand how to address them. Plus, the sharing happens year round as opposed to just at a few days at the conference.

Speaking of which, what do you think of Don’s thoughts above? Is he right? Is there something he’s missing? Is there more depth to this conversation that we need to understand? Share your thoughts, ideas, insights, and perspectives in the comments or on social media using the #HITExpo hashtag.

5 Ways Allscripts Will Help Fight Opioid Abuse In 2018

Posted on May 22, 2018 I Written By

The following is a guest blog post by Paul Black, CEO of Allscripts, a proud sponsor of Health IT Expo.

Prescription opioid misuse and overdoses are on the rise. The Centers for Disease Control and Prevention (CDC) reports that more than 40 Americans die every day from prescription opioid overdose. It also estimates that the economic impact in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.

The opioid crisis has taken a devastating toll on our communities, families and loved ones. It is a complex problem that will require a lot of hard work from stakeholders across the healthcare continuum.

We all have a part to play. At Allscripts, we feel it is our responsibility to continuously improve our solutions to help providers address public health concerns. Our mission is to design technology that enables smarter care, delivered with greater precision, for better outcomes.

Here are five ways Allscripts plans to help clinicians combat the opioid crisis in 2018:

1) Establish a baseline. Does your patient population have a problem with opioids?

Before healthcare organizations can start addressing opioid abuse, they need to understand how the crisis is affecting their patient population. We are all familiar with the national statistics, but how does the crisis manifest in each community? What are the specific prescribing practices or overdose patterns that need the most attention?

Now that healthcare is on a fully digital platform, we can gain insights from the data. Organizations can more precisely manage the needs of each patient population. We are working with clients to uncover some of these patterns. For example, one client is using Sunrise™ Clinical Performance Manager (CPM) reports to more closely examine opioid prescribing patterns in emergency rooms.

2) Secure the prescribing process. Is your prescribing process safe and secure?

Electronic prescribing of controlled substances (EPCS) can help reduce fraud. Unfortunately, even though the technology is widely available, it is not widely adopted. Areas where clinicians regularly use EPCS have seen significantly less prescription fraud and abuse.

EPCS functionality is already in place across our EHRs. While more than 90% of all pharmacies are EPCS-enabled, only 14% of controlled substances are prescribed electronically. We’re making EPCS adoption one of our top priorities at Allscripts, and we continue to discuss the benefits with policymakers.

3) Provide clinical decision support. Are you current with evidence-based best practices?

We are actively pursuing partnerships with health plans, pharmaceutical companies and third-party content providers to collaborate on evidence-based prescribing guidelines. These guidelines may suggest quantity limits, recommendations for fast-acting versus extended-release medications, protocols for additional and alternative therapies, and expanded educational material and content.

We’ll use the clinical decision support technologies we already have in place to present these assessment tools and guidelines at the time needed within clinical workflows. Our goal is to provide the information to providers at the right time, so that they can engage in productive conversations with patients, make informed decisions and create optimal treatment plans.

4) Simplify access to Prescription Drug Monitoring Programs (PDMPs). Are you avoiding prescribing because it’s too hard to check PDMPs?

PDMPs are state-level databases that collect, monitor and analyze e-prescribing data from pharmacies and prescribers. The CDC Guidelines recommend clinicians should review the patient’s history of controlled substance prescriptions by checking PDMPs.

PDMPs, however, are not a unified source of information, which can make it challenging for providers to check them at the point of care. The College of Healthcare Information Management Executives (CHIME) has called for better EHR-PDMP integration, combined with data-driven reports to identify physician prescribing patterns.

In 2018, we’re working on integrating the PDMP into the clinician’s workflow for every patient. The EHR will take PDMP data and provide real-time alert scores that can make it easier to discern problems at the point of care.

5) Predict risk. Can big data help you predict risk for addiction?

Allscripts has a team of data scientists dedicated to transforming data into information and actionable insights. These analysts combine vast amounts of information from within the EHR, our Clinical Data Warehouse – data that represents millions of patients – and public health mechanisms (such as PDMPs).

We use this “data lake” to develop algorithms to identify at-risk patients and reveal prescription patterns that most often lead to abuse, overdose and death. Our research on this is nascent, and early insights are compelling.

The opioid epidemic cannot be solved overnight, nor is it something any of us can address alone. But we are enthusiastic about the teamwork and efforts of our entire industry to address this complex, multi-faceted epidemic.

Hear Paul Black discuss the future of health IT beyond the EHR at this year’s HIT Expo.

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.

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.

CXO Scene Episode 3: EHR Cloud Hosting, the EMR Market, and Health IT Staffing Challenges

Posted on August 28, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you missed the live taping of the third CXO Scene podcast with David Chou, Vice President and Chief Information and Digital Officer at Children’s Mercy Kansas City and John Lynn, Founder of HealthcareScene.com, the video recording is now available below.

Here were the 3 topics we discussed on the 2nd CXO Scene podcast along with some reference links for the topics:
* Cloud hosting
http://www.fiercehealthcare.com/ehr/uc-san-diego-health-pushes-ehrs-to-cloud-uc-irvine-slated-for-november

* Future of the EMR market with McKesson acquisition
http://www.mckesson.com/about-mckesson/newsroom/press-releases/2017/allscripts-to-acquire-mckessons-enterprise-information-solutions-business/
http://www.hospitalemrandehr.com/2017/08/18/is-allscripts-an-also-ran-in-the-hospital-emr-business/

* IT staffing challenges

You can watch the full CXO Scene video podcast on the Healthcare Scene YouTube Channel or in the video embed below:

Note: We’re still working on distributing CXO Scene on your favorite podcasting platform. We’ll update this post once we finally have those podcast options in place.

Take a look back at past CXO Scene podcasts and posts and join us for the live recording of future CXO Scene podcasts.

Is Allscripts An Also-Ran In The Hospital EMR Business?

Posted on August 18, 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.

It all began with a question, as many classic tales do. Someone writing for the HIStalk.com website  – I think it was ever-anonymous, eponymous  leader Mr. HISTalk – asked readers to answer the question “Who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?”

The survey results were themselves worth a read:

* Approximately 29% voted for “McKesson customers”
* About 27% voted for “Allscripts customers”
* 8.4% voted for “McKesson shareholders”
* Roughly 23% voted for “Allscripts shareholders”
* About 13% voted for “Allscripts competitors”

Two things about these responses interested me. One is that almost a third of respondents seem to think McKesson will make the bigger score after being acquired by Allscripts. The other is that a not-inconsiderable 13% of the site’s well-informed readers think the deal will help Allscripts’ competitors. If these readers are right, perhaps Allscripts should rethink the deal.

I was even more engaged by the analysis that followed, which the writer took a close look at the dynamics of the hospital EMR market and commented on how Allscripts fit in. The results weren’t surprising, but again, if I were running Allscripts I’d take the following discussion seriously.

After working with data supplied by Blain Newton, EVP of HIMSS Analytics, the writer drew some firm conclusions. Here are some of the observations he shared:

  • While McKesson has twice as many hospitals as Allscripts, most of these hospitals have less than 150 beds, which means that the acquisition may offer less benefit, he suggests.
  • In addition to having only 3% of hospitals overall, Allscripts controls only 6% of the 250+ bed hospital market, which probably doesn’t position it for success. In contrast, he notes, Epic controls 20% of this market and Meditech 19%.
  • His sense is that while hospitals typically want a full suite of products when they work with Epic, Cerner or Meditech, Allscripts customers may be more prone to buying just a few key systems.
  • Ultimately, he argues, Cerner, Epic and Meditech have a commanding lead in this market, for reasons which include that the three are well ahead when it comes to the overall number of hospital served.
  • Given his premise, he believes that Epic is at the top of the pyramid, as it has almost double the number of hospitals with 500+ beds that Cerner does.

To cap off his analysis, Mr. HISTalk concludes that market forces make it unlikely that a dark horse will squeeze out one of the top hospital EMR vendors: “Everybody else is eating their dust and likely to lose business due to hospital consolidation and a shift toward the most successful vendors as much as all of us who – for our own reasons – wish that weren’t the case.”

It would take a separate analysis to predict whether the top three hospital EMR vendors are likely to win out over each other, but Epic seems to hold the most cards. Last year, I wrote a piece suggesting that Cerner was edging up on Epic, but I’m not sure whether or not my logic still holds. Epic may indeed be King of the (HIT) Universe for the foreseeable future.

Should You Buy Pop Health Tools And EMRs From One Vendor?

Posted on October 17, 2016 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.

According to a new story appearing in HealthITAnalytics, EMR vendors are increasingly moving into the population health management space. In fact, according to an IDC Research market report featured in the story, the lines between the EMR and population health management marketplaces are beginning to blur, with vendors offering products tackling both documentation and patient management.

While this is not news to anyone who’s attended a major industry tradeshow in the last few years, the extent of the transition might be. Apparently, half of the top population health management vendors featured by IDC – including athenahealth, eClinicalWorks and Allscripts — also offer EMR platforms. (According to HealthITAnalytics, other pop health vendors identified as leaders by IDC include Wellcentive, Medecision, Optum and IBM Phytel.)

Cynthia Burghard, Research Director with IDC Health Insights, says that providers want to integrate patient management and big data analytics to support their ACO deals and meet tregulatory requirements. In an IDC press release, she notes that providers need to manage both clinical and financial outcomes to survive under value-based reimbursement.

While all of this makes sense to me on paper, I’d like to raise a question here. Does buying both your EMR and your pop health tool from the same vendor have a meaningful downside? I’d argue that it might.

Yes, from a high level, buying an EMR and population health management engine from the same vendor is a good idea. In theory, the two are likely to work together more effectively than two platforms from two separate vendors, as there’s unlikely to be any conflict between the purposes of the EMR and the purposes of the population health tool.

But in practice, it’s worth bearing in mind that we haven’t yet evolved a standard feature set or business model for managing patients at the population level (though you might be interested in some of these emerging best practices). So this is a far bigger risk than buying, for example, a practice management tool and an EMR from the same vendor — after all, practice management software has been around long enough that it’s fairly standardized.

On the other hand, if you buy a population health tool and an EMR from, say, Allscripts, you’re buying not only technology but their view of how population health management should be done. And the two platforms are somewhat, for lack of a better word, inbred if they try to cover your entire scope of patient management. Whatever blind spots the EMR may have, the pop health management platform may have as well.

I guess what I’m trying to say here is that while it makes great business sense for the vendors to offer both EMR and pop health products, it’s not necessarily in the provider’s interests to pile both of those products onto their infrastructure. At this stage, I’d argue, it’s worth preserving your flexibility, even if you spend more or have to work harder to develop the business logic you need on the population health side.

But I’m willing to change my mind. Readers, what do you think?

E-Patient Update: Hospitals Need Virtual Clinicians

Posted on July 20, 2016 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.

Hospitals have a lot to lose if patients are readmitted not long after discharge. But in most cases, their follow-up care coordination efforts post-discharge are perfunctory at best.

My husband’s experience seems to be typical: a few weeks after his discharge, a nurse called and asked perhaps five or six very broad questions about his status. I doubt such as superficial intervention has ever done much prevent a patient from deteriorating. But this dynamic can be changed. As an active, involved e-patient, I think it’s time to bring artificial intelligence technology into the mix.

In recent times, AI platforms have emerged that may offer a big improvement on the, well, largely nothing hospitals do to prevent patients from deteriorating after they leave the facility. In fact, artificial intelligence technology has evolved to the point where it’s possible to provide a “virtual clinician” which serves as a resource for patients.

One example of this emerging technology comes from AI startup Sense.ly, which has developed a virtual nurse named Molly. According to the company, Molly is designed to offer customized patient monitoring and follow-up care, particularly for patients with chronic diseases. Its customers include the UK’s National Health Service, Kaiser Permanente, San Mateo Medical Center, University of California San Francisco, Microsoft and Allscripts.

Molly, an avatar-based system which was designed to mimic the bedside manner patients crave, can access data to assist with real-time care decisions. It also monitors vital signs – though I imagine this works better with a remote connected device — and tracks patient compliance with meds. Molly even creates custom questionnaires on the fly to assess patients, analyzes those responses for risk, and connects patients directly to real- life clinicians if need be.

While this is admittedly a groundbreaking approach, some independent research already exists to suggest that it works. Back in 2011, Northeastern University researchers found that patients who interacted with virtual nurse Elizabeth were more likely to know their diagnoses and make follow-up appointments with their doctor, ZDNet reports.

And if you’re afraid that using such a tool exposes your facility to big legal risks, well, that’s not necessarily the case, according to veteran healthcare attorney David Harlow.

“The issue is always in the terms of use, and if you frame that properly – and build the logic properly – you should be OK,” Harlow told me. He concedes that if hospitals can be sued for patient care problems generated by EMR failures — which happens now and then — a cause of action could arise from use of virtual clinician. But my sense from talking with him was that there’s nothing inherently more dangerous about deploying an AI nurse than using any other technology as part of care.

Speaking for myself, I can’t wait until hospitals and medical practices deploy a tool like Molly, particularly if the alternative is no support at all. Like those who tested Elizabeth at Northeastern University, I’d find it much easier to exchange information with an infinitely patient, focused and nonjudgmental software entity than a rushed nurse with dozens or hundreds of other patients on their mind.

I realize that I’m probably ahead of the market in my comfort with AI technology. (My mother would have a stroke if you asked her to interact with a virtual human.) But I’d argue that patients like me are in the vanguard, and you want to keep us happy. Besides, you might be pleasantly surprised by the clinical impact such interventions can have. Seems like a win-win.

Hospital EMR Buyer Loyalty May Be Shaky

Posted on February 22, 2016 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 it comes to investing in enterprise software, just about any deal can turn sour. If you’re acquiring a mission-critical platform, there’s an even bigger risk involved, and the consequences of failure are typically dire. So any company making such a purchase may feel trapped after the contract is signed and the die has been cast.

One might hope that when hospital and health systems buy an EMR — probably the most expensive and critical software buy they’ll make in a decade — that they feel comfortable with their vendor. Ideally, hospitals should be prepared to switch vendors if they feel the need.

In reality, however, it looks like many hospitals and health systems feel they’re trapped in their relationship with their EMR vendor. A new study by research firm Black Book has concluded that about a solid subset of hospitals feel trapped in their relationship with their EMR vendor. (Given what I hear at professional gatherings, I’m betting that’s on the low side, as their EMR has driven so many hospitals deep into debt.)

Anyway, Black Book compiles an HIT Loyalty Index which assesses the stability of vendors’ customer base and measures those customers’ loyalty. For its current batch of stats, Black Book drew on 2,077 hospital users, asking about their intentions to renew current contracts, recommend their inpatient EMR/HIT vendor to peers and the likelihood of their buying additional products like HIE and RCM tools from their existing vendors.

The results shouldn’t give any great pleasure to HIT vendors. All told, loyalty to inpatient EMR/HIT vendors fell 6%, from 81% to 75% committed clients. While it’s not horrible to have 75% truly happy with your product, this is not a metric you want to see trending downward.

When you combine these numbers with other signs of dissatisfaction, the picture looks worse. Roughly 25% of respondents said that they were only loyal to their vendor because they were forced to follow administrative directives. And as we all know, ladies and gents of the vendor world, you can’t buy love. These 25% of dissatisfied professionals will do their job, but they aren’t going to evangelize for you, nor will they be quick to recommend more of your products.

All is not bleak for EMR vendors, however. Some HIT vendors saw year-to-year growth in hospital client loyalty. Vendors with the biggest loyalty increases included Allscripts, Cerner, CPSI, NTT Data and athenahealth/RazorInsights.

By the way I noted, with a touch of amusement, that mega-costly Epic doesn’t appear on the latter list. Just sayin’.

EMR Usability A Pressing Issue

Posted on January 29, 2016 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 few months ago, in a move that hasn’t gotten a lot of attention, the AMA and MedStar Health made an interesting play. The physicians’ group and the health system released a joint framework designed to rank EMR usability, as well as using the framework to rank the usability of a number of widely-implemented systems.

What makes these scores interesting is not that they’re just another set of rankings — those are pretty much everywhere — but that the researchers focused on EMR usability. As any clinician will tell you (and many have told me) despite years of evolution, EMRs are still a pain in the butt to use. And clearly, market forces are doing little to change this. Looking at where widely-used systems rate on usability is a refreshing look at a neglected issue.

To score the EMRs, researchers dug into EMR vendor testing reports from ONC. This makes sense. After all, though the agency doesn’t use this data for certification, the ONC does require EMR vendors to report on user-centered design processes they used for eight capabilities.

And while the ONC doesn’t base EMR certifications on usability, my gut feeling is that the data source is pretty reliable. I would tend to believe that given they’re talking to a certifying authority, vendors are less like to fudge these reports than any they’d prepare for potential customers.

According to the partners, Allscripts and McKesson were the highest-scoring EMR vendors, gaining 15 out of 15 points. eClinicalWorks was the lowest-scoring EMR, getting only 5 of 15 possible points. In-betweeners included Cerner and MEDITECH, which got 13 points each, and Epic, which got 9 points.

And here’s the criteria for the rankings:

  • User Centered Design Process:  EMRs were rated on whether they had a user-centered design process, how many participants took part (15+ was best) and whether test participants had a clinical background.
  • Summative Testing Methodology: These ratings focused on how detailed the use cases relied upon by the testing were and whether usability measures focused on appropriate factors (effectiveness, efficiency and satisfaction).
  • Summative Testing Results:  These measures focused on whether success rates for first-time users were 80% or more, and on how substantive descriptions of areas for improvement were.

Given the spotty results across the population of EMRs tested, it seems clear that usability hasn’t been a core concern of most vendors. (Yes, I know, some of you are saying, “Boy howdy, we knew that already!”)

Perhaps more importantly, though, it can be inferred that usability hasn’t been a priority for the health systems and practices investing in these products. After all, some of the so-so ratings, such as that for the Epic product, come from companies that have been in the market forever and have had the time to iterate a mature, usable product. If health systems were demanding that EMRs be easy to use, the scores would probably be higher.

Frankly, I can’t for the life of me understand why an organization would invest hundreds of millions of dollars (or even a billion) dollars in an EMR without being sure that clinicians can actually use it. After all, a good EMR experience can be very attractive to potential recruits as well as current clinicians. In fact, a study from early last year found that 79% of RNs see the hospital’s EMR as a one of the top 3 considerations in choosing where to work.

Maybe it’s an artifact of a prior era. In the past, perhaps the health systems investing in less-usable EMRs were just making the best of a shoddy situation. But I don’t think that excuse plays anymore. I believe more providers need to adopt frameworks like this one, and apply them rigorously.

Look, I know that EMR investment is a complex dance. And obviously, notions of usability will continue to evolve as EMRs involve — so perhaps it can’t be the top priority for every buyer. But it’s more than time for health organizations to take usability seriously.