Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

In The Aftermath Of Sutter Health EMR Crash, Nurses Raise Safety Questions

Posted on May 24, 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 mid-May, Sutter Health’s Epic EMR crashed, accompanied by other technical problems. Officials said the system failures were caused by the activation of the fire suppression system in one of their IT buildings.

As you might expect, employees at locations affected by the downtime weren’t able to access patient medical records. On top of that, they didn’t have access to email or even use their phones. In addition, the system had to contact some patients to reschedule appointments.

On the whole, this sounds like the kind of routine issue which, though embarrassing, can be brought to heel if an organization does the disaster planning and employee training on how to react to the situations.

According to some nurses, however, Sutter Medical Center may not have handled things so well. The nurses, who spoke on condition of anonymity with The Sacrament Bee, told the newspaper that the hospital moved ahead with some forms of care before the outage was completely resolved.

The nurses told that when some patients were admitted after the systems failure, clinicians still didn’t have access to critical patient information. For example, a surgical nurse noted that the surgical team relies upon EMR access to review patient histories and physicals performed within the previous 30 days. According to Sutter protocols, these results need to be certified by the physician as still being valid on the date of surgery.

Instead, patients were arriving with their histories and physical exam records on paper, and those documents didn’t include the doctor’s certification that the patient’s condition hadn’t changed. If something went wrong during elective surgery, the team would’ve had to rely on paper documents to determine the cause, the nurses said.

They argue that Sutter Medical Center shouldn’t have taken those cases until the EMR was fully online. “Other Sutter hospitals canceled elective surgeries,” one nurse told a reporter. “Why did Sutter Medical Center feel like they needed to do elective surgeries?”

Also, they say that at least one surgical procedure was affected by the outage, when a surgeon needed a particular instrument to proceed. Normally, they said, operating room telephones display a directory of numbers to supply rooms or nurse stations, but these weren’t available and it forced the surgical team to break its process. Under standard conditions, the team tries not to leave the operating room because a patient’s condition can deteriorate in seconds. In this case, however, a nurse had to hurry out of the room to get instruments the surgeon needed.

While it’s hard to tell from the outside, this sounds a bit, well, unseemly at best. Let’s hope Sutter’s decision-making in this case was based on thoughtful decisions rather than a need to maintain cash flow.

Let this also be an important reminder to every healthcare organization to make sure you have well thought out disaster plans that have been communicated to everyone in your organization. You don’t want to be caught liable when disaster strikes and your staff start free wheeling without having thought through all of the potential consequences.

Sutter Health Blends EHR, Patient-Reported Data For MS Treatment

Posted on December 5, 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.

The Sutter Health network is launching a new research project which will blend patient-reported and EHR-based data to improve the precision of multiple sclerosis treatment. Sutter will fund the project with a $1.2 million award from the California Initiative to Advance Precision Medicine.

To conduct the project, Sutter Health researchers are partnering with colleagues at the University of California, San Francisco. Working together, the team is developing a neurology application dubbed MS-SHARE which will be used by patients and doctors during appointments, and by patients between appointments.

During the 18-month demonstration project, the team will build the app with input from the health system’s doctors as well as MS patients. Throughout the process of care, the app will organize both patient-reported data and EHR data, in a manner intended to let doctors and patients view the data together and work together on care planning.

Over the short term, researchers and developers are focusing on outcomes like patient and doctor use of the app and enhancing the patient experience. Its big picture goals, meanwhile, include the ability to improve patient outcomes, such as disease progression and symptom control. Ultimately, the team hopes the results of this project go beyond supporting multiple sclerosis patients to helping to improve care for other neurological diseases such as Parkinson’s Disease, seizure disorders and migraine headaches.

The Sacramento, Calif.-based health network pitches the project as potentially transformative. “MS-SHARE has the potential to change how doctors and patients spend their time during appointments,” the press release asserts. “Instead of ‘data finding and gathering,’ doctors and patients can devote more time to conversation about how the care is working and how it needs to be changed to meet patient needs.”

Time for an editorial aside here. As a patient with a neurological disorder (Parkinson’s), I’m here to say that while this sounds like an excellent start at collaborating with patients, at first glance it may be doomed to limited success at best.

What I mean is as follows. When I meet with the neurologist to discuss progression of my symptoms, he or she typically does little beyond the standard exam. In fact, my sense is that most seem quite satisfied that they know enough about my status to make decisions after doing that exam. In most cases, little or nothing about my functioning outside the office makes it into the chart.

What I’m trying to say here is that based on my experience, it will take more than a handy-dandy app to win neurologists over to collaborating over charts and data with any patient. (Honestly, I think that’s true of many doctors outside this specialty, too.) And I’m not suggesting that this is because they’re arrogant, although they may be in some cases. Rather, I’m suggesting that it’s a workflow issue. Integrating patients in the discussion isn’t just a change of pace, it could be seen as a distraction that could lead to worse care rather than better. It will be interesting to see if that’s how things turn out.

When Your EHR Goes Down…And It Will

Posted on March 5, 2015 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.

Erin McCann at Healthcare IT News wrote a recent report on a McKesson EHR outage at Rideout Health after an HVAC unit burned out. In the article she also talks about the $1 billion (I love that she added the price tag) Epic EHR outage that occurred in August 2013 at Sutter Health and lasted an entire day. Plus, she mentions the IT network failure at Martin Health System in January 2014 and had their Epic EHR down for 2 days. I’m sure there are many more that were shorter or just weren’t reported by news outlets.

When I think about EHR downtime I’m reminded of the Titanic. You can invest all you want in the “unsinkable” EHR implementation and unexpected downtime will still occur. Yes, much like the Titanic that everyone thought was totally unsinkable, it now lies at the bottom of the ocean as a testament to nature’s ability to sink anything. That includes causing your EHR to go down.

Let’s say your EHR is able to have 99.9% uptime. That would feel pretty good wouldn’t it. Well, that turns out to be 8 hours 45 minutes and 57 seconds over the year. That’s still a full working day of downtime. If you expand to 99.99% downtime, that’s still 52.56 minutes of downtime. At 99.999 (Five Nines as they say in the industry) of downtime is 5.39 minutes of downtime.

The challenge is that with every 9 you add to your reliability and uptime requirements the costs increase exponentially. They don’t increase linearly, but exponentially. Try getting that exponential cost curve approved by your hospital. It’s not going to happen.

Another way to look at this is to consider tech powerhouses like Google. They have some of the highest quality engineers in the world and pay them a lot more than you’re paying your hospital tech staff. Even with all of that investment and expertise, they still go down. So, why would we think that our hospital EHR could do better than Google?

One way many organizations try to get a Google like uptime in their organizations is to use an outside data center. Many of these data centers are able to implement and invest in a lot of areas a hospital could never afford to invest in. Of course, these data centers only provide a few layers of the technology stack. So, they can minimize downtime for some things, but not all.

The real solution is to make sure your organization has a plan for when downtime occurs. Yes, this basically means you assume that your EHR will go down and what will you do? This was my first hand experience. At one point the EHR that I implemented went down. The initial reaction was fear and shock as people asked the question, “What do we do?” However, thanks to a strong leader, she pulled out our previously created plan for when the EHR went down. Having that plan and a strong leader who reminded people of the plan calmed everyone down completely. It still wasn’t fun to have the EMR down, but it was definitely manageable.

What have you done to prepare for EHR downtime? Do you have a plan in place? Have you had the experience of having your EHR down? What was it like? Are you afraid of what will happen in your hospital when your EHR goes down?

Sutter Health Ready To Deploy HIE, But Can It Succeed?

Posted on June 30, 2014 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.

Sutter Health doesn’t have a great reputation when it comes to EMR implementation. Late last year, when we reported that Sutter’s Epic EMR crashed for an entire day, comments came pouring in about the company’s questionable approach to training its staff on using the system.

According to Epic consultants who’d been involved in the project, Sutter leaders decided that Epic experts were there to “facilitate” training done by inexperienced in-house teams, rather than actually teach key users what they need to know. The result was strife, disorder and anxiety, according to several consultants who’d been involved. Since then, Sutter has connected its EMR to five medical foundations and 17 hospital campuses; by next year, it expects the EMR to connect to information on 3 million patients. But there’s no reason to think it’s changed its training strategy, which could cast a bit of a pall over the new project.

Now, Sutter Health is building out a health information exchange, working with Orion Health, which will tie together hospitals and doctors both inside and outside of its network across northern California. Sutter plans to begin deploying the HIE in phases this summer, starting with data integration with the Epic EMR and extending to testing exchange of inbound and outbound data. If the project works out, it seems likely that it will be a plus for every provider that does business with Sutter.

The question is, will Sutter do a better job of managing this process than it did in rolling out its EMR? While it’s easy to boast that your plans are going to be a “gamechanger” for the market, it’s hard to take that claim at face value when your EMR implementation hasn’t gone so splendidly.

Certainly, Orion is a reputable HIE vendor which has been praised for having strong products and service. And Sutter certainly has the financial wherewithal to see such an effort through. The thing is, if Sutter leaders (seemingly) took a wrongheaded approach to the all-important issue of EMR training, who knows what curveballs they might throw into the process of rolling out an HIE? Even if its EMR has stabilized and Sutter has somehow gotten past its training hurdles, its past missteps don’t inspire confidence.

If I were with Orion, I’d draw a firm line where training was concerned, as Sutter’s past strategy only seems to have cast its last major HIT vendor in a bad light. If not, I’d make sure the contract had a workable bailout clause…or be prepared for some serious headaches.

Kaiser Permanente Branch Joins Epic Network

Posted on December 26, 2013 I Written By

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

Though it apparently held out for a while, Kaiser Permanente Northern California has signed on to Epic Systems’ Care Everywhere, a network which allows Epic users to share various forms of clinical information, Modern Healthcare reports.

Care Everywhere allows participants to get a wide range of patient data, including real-time access to patient and family medical histories, medications, lab tests, physician notes and previous diagnoses. The Care Everywhere network debuted in California in 2008, and has since grown to a national roster of more than 200 Epic users.

Many of the state’s major healthcare players are involved, including Sutter Health, as well as prominent regional players such as Stanford Hospital and Clinics, USCF Medical Center and UC Davis Health System, according to Modern Healthcare. Kaiser Permanente Southern California also participates in the network.

According to Epic, the Care Everywhere system allows patients to take information with them between institutions whether or not both institutions use the Epic platform. Information can come from another Epic system, a non-Epic EMR that complies with industry standards, or directly from the patient.

But of course, the vendor likes to see Epic-to-Epic transmission best, as it notes on the corporate site: “When an Epic system is on both sides of the exchange, a richer data set is exchanged and additional conductivity options such as cross-organization referral management are available.”

Care Everywhere also comes with Lucy, a freestanding PHR not connected to any facility’s EMR system. According to Epic, Lucy follows patients wherever they receive care, and gathers data into a single source that’s readily accessible to clinicians and patients. Patients can enter health data directly into Lucy or upload Continuity of Care Documents from other facilities.

While connecting 200+ healthcare organizations together is a notable accomplishment, Care Everywhere is not going to end up as the default national HIE matter how hard Epic tries. As long as the vendor behind the HIE (Epic) has a strong incentive to favor one form of data exchange over another, it cuts down the likelihood that you’ll have true interoperability between these players. Still, I’ve got to admit it’s a pretty interesting development. Let’s see what healthcare organizations have to say that try to work with Care Everywhere without owning an Epic system.

P.S. It’ll also be interesting to see whether Epic is actually “best” for ACOs, as a KLAS study of a couple of years ago suggested. More recent data suggests that best-of-breed tools will be necessary to build an ACO, even if your organization has taken the massive Epic plunge.

Sutter Health Switching Early To ICD-10

Posted on November 6, 2013 I Written By

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

Though the industry has until October 2014 to meet the deadline for ICD-10 go-live, some health systems are gearing up to get there well in advance.

One system which has gone public with its plans is Sutter Health, whose go-live date will be May 31, 2014, according to a story in Healthcare IT News.

The health system, which unveiled its plans at this week’s AHIMA convention, won’t be submitting claims to payers in ICD-10 right away, but it will turn on the new codes for physician use, said Danielle Reno, ICD-10 program director for Sutter.

Sutter faced a formidable challenge when planning its rollout, as it has relationships with roughly 5,200 physicians across 24 acute care hospitals.

To prepare for the rollout, Sutter began by getting key staff and management on board, and making sure they understood the timelines they’d need to meet and the impact to their budgets, Healthcare IT News said.

Also, as part of the teaching process, Sutter made 30- and  60-minute online educational videos available starting in July. The idea was to gear up employees to serve as change agents across 27 medical specialties.

Sutter also identified physician champions who were given privileges to take ICD-10 back to their departments each month, the same physicians who already communicate about any changes to Sutter’s EMR, the magazine reports.

In addition to these efforts, after learning that doctors preferred training from someone in their specialty, Reno started offering all-day sessions in which doctors could learn with their peers. This has been a “great success,” Reno said.

If your organization hasn’t begun preparations for the ICD-10 switchover, there’s obviously not a moment to waste. In addition to getting training going, you’ll want to make sure your EMR vendor is ICD-10 ready. Wouldn’t it be a rude shock to find out too late that it isn’t?

Lessons Learned from Sutter’s EHR Implementation Challenges

Posted on September 25, 2013 I Written By

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

One of our more popular recent posts was published on EMR and HIPAA and was titled, “Adding Insult To Injury, Sutter’s Epic EMR Crashes For A Day.” When the post was shared on LinkedIn, it prompted a really insightful discussion on EMR training and Sutter’s approach to EHR implementation. A few of the comments were so good that I wanted to share them for more people to read and learn.

The first comment is from Scott Kennedy, an Epic Stork Trainer:

I was an Epic training consultant on the E. Bay Sutter EHR implementation and I can tell you first hand that Sutter Admin, and the Nurses are at odds. This unfortunate relationship made it difficult to train the staff. Epic itself is not to blame. Those who are using the Epic EHR are not as trained as they should be.

Sutter used an “in house” training team rather than bringing on a full consulting team with much more experience in training and educating end users. The “in house’ trainers included some nurses, RTs, and the like as well as a host of newly graduated college students who had less to no experience with conducting a formal training presentation on a multidisciplinary EHR.

Hiring and training “in house” is a great addition to bringing on an experienced, skilled, professional team of Epic credentialed trainers, like myself who do this as a profession all over the country.

We were also directed by Sutter EHR implementation Administration to “facilitate” rather than “train.” “Facilitate included passing out exercise booklets to the clinical end users and having them work on their own, rather than conducing concise, lectured, guided practice prior to each exercise. Hands on exercises are an essential part of the training, but should not be the complete focus of training.

The learner is left on their own to figure out the system, which is counter productive. That approach only builds anxiety, confusion and eventual resentment for the system and the administration who have chosen the EHR they are fumbling through.

I empathize with the clinical end users. There training experience could have been much more instrumental in getting them off on the right foot with their new EHR, had the training approach been more adult learning theory based rather than self-learning based.

I only wish I could come back to Sutter and retrain the nurses and other clinicians from the proven, consistent, progressive, successful adult learning approach, which enables and empowers the end user to grasp, comprehend and assimilate the EHR system into their daily shift work flow. That is not to say that there are not implementation bumps and optimization needs that have to be addressed, but they are far less impactful when the clinician is properly trained.

I am so sorry Sutter nurses and staff that I trained, but I was firmly told to “facilitate” your learning rather than “train” you. I tried to implement adult learning methodology, but was told by your EHR administration to “stop talking and let them do it on their own.”

Epic EHR is not to blame here. Epic is a sound, EHR system that is serving the needs of millions of patients and their care providers around the world, without incidents such as those being experienced at Sutter.

There is a right way to implement and train and a wrong way. Sorry Sutter EHR implementation administration, but “I told you so!”

I asked Scott Kennedy if he’d thought of leaving the project since it was being done the wrong way and he offered the following response:

@ John, yes I did come very close to leaving the project. As a matter of fact after I was verbally “scolded” for lecturing to much I phoned my recruiter and asked to be placed on another project, but then, after careful thought, I decided to stay on the project and attempt to train and support as much as I could. But it seems that my individual efforts were not enough to counter the original training “facilitation” focus.

To add insult to injury those of us trainers who were there for the Sutter E. Bay implementation were told not to return for the W. Bay implementation. The EHR administration wanted an entirely new outside consulting team.

I got a fellow colleague on the project, hoping that the E. Bay administration would have learned from and the current W. Bay implementation would be better. The training colleague I got on the W. Bay project shared with me that it was worse than the E. Bay implementation. They kept the experienced Epic trainers as support and utilized them as little as possible for actual front end training. So sad, really.

The EHR administration at Sutter tried to cut every financial corner possible and lost sight of the long run implications of improper front end training. Now they are paying the price.

Michael A. P., an EMR consultant offered this insight as well:

I’ve also had the misfortune of working with Sutter for a (thankfully) brief period. In their long history of attempting to implement Epic, they could be counted on to make the wrong decision in almost every situation. Their internal politics trump the advice they receive from vendors and highly experienced consultants. The result is an implementation that serves neither the patient or the users best interests.

Then, Ryan Thousand, an IT Architect at Athens Regional Medical Center, offered a broader view of what’s happening in health IT and EHR:

I hate to say it but most large healthcare organizations are getting like this as well…. There are WAY too many layers in these organizations and sometimes to get work done can mean 4 weeks of executive meetings and in the end no decision or 100% opposite of the recommended direction given. That being said, with the rapid change in healthcare and the mergers and acquisitions occurring right now, I fear the worries for Healthcare in general over the next couple of years. We cannot continue to try to meet mandates the government is making while still ensuring 100% utmost patient care; and in the end that is really all I care about.. the patient in the bed who is BENEFITING from my implementation. Change is always tough but done the right way with the right people (as you all stated above was not done correctly) we will continue to see great things happen on the HIT side. But unless Epic/Cerner all the big players in the markets as well as the local clinician and providers work together and decide the best outcomes for our patients, we will all one day suffer, as we will all one day be patients.

In all the years I’ve been writing about EMR and EHR, the biggest problem with most EMR implementations is lack of EHR training or poor EHR training. It’s really amazing the impact quality EHR training can have on an implementation. However, many organizations use that as a way to save money. If they could only see the long term costs of that choice.