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EMR Alert Fatigue Can Have Deadly Consequences

Posted on May 31, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A case study published this week in the journal Pediatrics suggests that EMR alert fatigue is becoming a major source of potential medical errors.  According to a piece in iHealthBeat, “a deluge of repetitive, inappropriate alerts” have been generated by EMRs of late, causing clinicians to ignore or override alerts very frequently.

Problems with alerting in medication order entry systems are proving to be a particularly serious safety hazard, it seems.  “It has been well established that clinicians override many drug allergy alerts generated by the electronic health record,” write the authors of the Pediatrics study.

The case study in Pediatrics comes from researchers at Stanford University Biomedical Informatics and Harvard Medical School.  Researchers examined the case of a two-year-old boy who died after clinical staff overrode scores of distracting EMR alerts — more than 100 over the course of one month — and ended up inappropriately administering a diuretic to the patient.

The key to addressing this  problem appears to be zeroing in on approaches to minimize the number of non-evidence based alerts that bedevil physicians during their time with patients. However, implementing these changes can be very complex.

In the PICU researchers were observing for their study, the facility made evidence-based allergy alerting alerts to the hospital’s system. However, that’s just one aspect of a multifaceted problem.  As the authors note, “incorporating clinical evidence in electronic drug allergy alerting systems remains challenging, especially in pediatric settings.”

But given that pediatric patients usually can’t themselves alert doctors or nurses when the wrong drug comes to hand, this seems like it should be a priority when looking at ways to reduce EMR alert fatigue.

“Breadwinner Moms” and #HITChicks

Posted on May 30, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

You’ve got to wonder at the title of a new Pew Research Center survey, so aptly called “Breadwinner Moms.” It’s catchy, for sure, but at the same time carries with it a hint of guilt that so many of us working moms are all too familiar with.

The survey found that “40% of all households with children under the age of 18 include mothers who are either the sole or primary source of income for the family.” That’s up 29% in the last 53 years, which isn’t all that surprising since, as the survey found, women now make up 47% of the labor force. I hope that we’re all fairly familiar with the historical and cultural forces behind these increased percentages.

Though not surprising to me, as the majority of my female contemporaries work and have children, I do wonder what portion of women in healthcare IT – or #HITchicks, as I like to call them on Twitter – are a part of this growing group. I’d safely bet that at least 50% of the women I work with have children at home. Ladies, do you see similar statistics play out at your organizations?

While this number seems to be increasing, I think it is also causing the “mommy guilt” so many of us feel at one time or another to ease a bit. At least we have other moms to commiserate with once we get to the office. I think parents today are fortunate that many in the corporate world have embraced telecommuting and working from home. (Though with young children at home this summer, I find myself more productive working in the office. My four-year old just can’t wrap her head around the need to not bother me when my home office door is closed.)

I wonder if this survey, and the general topic of women in the workplace, will be brought up at the “Women as Leaders” session at the upcoming HFMA ANI conference in Orlando. This will be my third time attending, and I find that I enjoy it just as much as I do HIMSS.

The session description reads, “Join a lively and inspiring conversation with the women on HFMA’s Board of Directors about how women can thrive as leaders in a highly demanding environment. Although women have long held leadership positions in health care, barriers to these roles continue to exist. Learn how the women on HFMA’s Board of Directors have achieved a seat at the leadership table and made their voices heard.”

They’ll “identify core skills women need for leadership success, such as self-confidence, team management, and negotiation; help women new to leadership roles excel and embrace the challenges they face; and share success stories for managing careers, families and communities.”

It’s the “families” part I’m most interested in hearing about. Though I love my career so much that I don’t see myself ever totally give it up, I’ve realized the term has to be fluid – changing in shape and definition to meet the needs of my family, which at the end of the day trumps career – and being the breadwinner – every time.

Practice Fusion Announces 3 Billing Partners

Posted on May 29, 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.

With the news of Mitochon shutting down their Free EHR business, that really only leaves a couple players left in the Free EHR space. The largest one is Practice Fusion, but it has challenges of its own. You might remember the announcement that Kareo bought the Epocrates EHR and is offering the EHR for free.

You could tell that Practice Fusion was put in a bad position when Kareo decided to basically part ways and offer a competitive product to Practice Fusion. Although, no doubt Practice Fusion and Kareo both knew it was going to happen sooner or later. The key question was how Practice Fusion was going to respond to the move by Kareo since Practice Fusion was sorely lacking in the billing department.

Well, the answer is now in. Practice Fusion just announced 3 preferred billing partners: NueMD, CollaborateMD and ADP AdvancedMD. You can see NueMD’s press release about the partnership here. Both NueMD and CollaborateMD are offering their billing solution starting at $149/month. ADP AdvancedMD offers “customized pricing” which means they don’t want to commit to a price and likely change the price based on the size of the practice.

The Practice Fusion announcement I got did say that these integrations will happen “later this summer.”

It’s an interesting choice on Practice Fusion’s part to continue down the integration road versus developing their own billing software or just buying one of the billing software that’s out there. I wonder if this is going to pose a long term problem for them. I wonder if Practice Fusion learned from the Kareo experience and the contracts with NueMD, CollaborateMD, and ADP AdvancedMD take this into account.

No doubt Practice Fusion comes at the EHR world with a different business model in mind, but it could be a mistake for them to not also have a hand in the purse strings (billing). Sure, they’ll get some short term financial bump from these three partnerships, but are they trading revenue for long term connections with the doctors?

eHealth Pilot Helps Chronically Ill

Posted on May 28, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

An 18-month pilot in one of Rio de Janeiro has demonstrated that even a small amount of health IT tools, applied to the right population, can have a significant effect on targeted patients’ health.

To conduct the pilot, the New Cities Foundation and GE Healthcare set out to test out a model which would improve access to primary care in a poor urban community, reports PMLive. (Note: The New Cities Foundation was established by GE, Cisco and Ericsson.)

The partners gave a clinic in the Santa Marta favela in Rio a GE-created eHealth kit, capable of fitting in a backpack, which contained a set of tools to measure key health indicators.  The materials in the kit, if purchased by outside parties, would usually cost about $42,000.

Clinic staff used the portable set of tools to visit 100 elderly patients living with chronic illness and mobility issues, in an effort to offer these patients a comprehensive diagnosis, the publication said.

According to a report created on the project by the Foundation, the results were substantial. Cost savings due to avoiding adverse clinical events included $4,000 (heart failure) to $200,000 (kidney failure) per 100 elderly patients.  Meanwhile, the pilot saved $136,000 per 1,000 patients by avoiding hospitalizations of those with cardiovascular diseases.

Time and time again, research shows that proactively providing preventive care takes costs out of the health system. This model, which seems like it could be duplicated easily in the U.S., should be tested widely in urban “health deserts” here. Any approach which brings primary care to where the frail, immobile elderly are seems almost guaranteed to be a winner.

Memorial Day

Posted on May 27, 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.

We took the day off from posting today for Memorial Day. Although, I did write this personal story about Memorial Day for those that might be interested.

It’s always great to honor those who’ve fought for us. I hope everyone had a great Memorial Day and not a great BBQ Day.

Epic References and The Winning EHR Solution

Posted on May 26, 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.

I think that Jonathan Bush has started a trend in the EHR world where people now abuse use of the adjective epic. In some ways it’s similar to the way that the word “meaningful” has now been corrupted for all of us in the EHR world. Here’s a couple tweets that show examples of the word Epic being used in interesting ways.

And another example from ePatient Dave:

There goes the word epic in my vocabulary.


I know a lot of people differentiate EHR from PM. I think they’re slowly growing into one software system. The winning EHR will have to deal with both. I wonder what else it will have to do. I’m certain that basic EHR and PM won’t be enough.

Is Skinny Data Harder Than Big Data?

Posted on May 24, 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.

On my post about Improving the Quality of EHR data for Healthcare Analytics, Glenn made a really great comment that I think is worth highlighting.

Power to change outcomes starts with liberating the data. Then transforming all that data into information and finally into knowledge. Ok – Sorry, that’s probably blindingly obvious. But skinny-data is a good metaphor because you don’t need to liberate ALL the data. And in fact the skinny metaphor covers what I refer to as the data becoming information part (filter out the noise). Selective liberation and combination into a skinny warehouse or skinny data platform is also manageable. And then build on top of that the analytics that release the knowledge to enable better outcomes. Now …if only all those behemoth mandated products would loosen up on their data controls…

His simple comment “filter out the noise” made me realize that skinny data might actually be much harder to do than big data. If you ask someone to just aggregate all the data, that is a generally pretty easy task. Once you start taking on the selection of data that really matters, it becomes much harder. This is likely why so many Enterprise Data Warehouses sit their basically idle. Knowing which data is useful, making sure it is collected in a useful way, and then putting that data to use is much harder than just aggregating all the data.

Dana Sellers commented on this in this Hospital EHR and Healthcare Analytics video interview I did (the whole video has some great insights). She said that data governance is going to be an important challenge going forward. Although she defined data governance as making sure that you’re collecting the data in a way that you know what that data really means and how it can be used in the future. That’s a powerful concept and one that most people haven’t dug into very much. They’re going to have to if they want to start using their data for good.

Legacy EMR Bloggers

Posted on May 23, 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.

Today I had an Italian friend of mine (I lived there for 2 years) find me on Facebook. I hadn’t seen or heard from the man in 10, almost 11 years. It was a joyous reunion and fun to catch up. I really hold relationships dear and truly love seeing people I haven’t seen in years.

One of the funny blogger stories I have was when I reached out to Christina Thielst from Christina’s Considerations. She loves to tell this story to people. First, you have to know that Christina’s blog was one of the first healthcare IT blogs I found when I began blogging 7.5 years ago. In fact, I must admit that I barely knew her name. I always just thought of her as the RHIO (there’s an old term for you) blogger.

Well, 6 years or so later I saw her name and picture on LinkedIn and so I decided to request that we connect. She politely replied that she declined my connection because she only connected with people she knew on LinkedIn. I was a little sad at the response, but replied that she probably had forgotten me and that we’d known each other’s blogs for many years. She then replied with a request to connect and an apology for not recognizing my name. It turns out she was like me and only knew the name of my blog and not my name.

As I thought about these long term relationships it’s fun for me to look back at which blogs were around when I first starting blogging about EMR. Here are a few that come to mind:

Neil Versel – I’m happy that I now consider Neil a friend, but when I first started blogging I looked to him and learned. He was and is a professional journalist and I was just a hack. I learned a lot from him and modeled a lot of what he was doing.

Healthcare Guy – I was always amazed at the stuff Shahid would write on his blog and enjoyed HITSphere which he created. Now he’s my partner in two businesses which we first talked about creating after we met in person at a HIMSS press room. I’m still amazed every time I’m on a call with Shahid. I like to just sit back, listen and learn from him.

HIStalk – I think Mr. H remembers those good old days. The funny thing is that when I first came across his posts they didn’t make much sense to me. They’re so full of industry jargon that it was like reading another language for me. Of course, now it’s often news and rumors I’ve already heard, but I still enjoy his wit. It’s like picking up the healthcare IT tabloids. You can’t look away. Plus, Inga is a sweetheart, even if she won’t tell me who she is. Maybe the Inga mystery is better.

Dalai’s PACS Blog – Sadly someone I have yet to meet in person. The PACS blog was and always has been an irreverent mix of many topics sprinkled with PACS talk. I have a feeling that the blog reflects the writer, which is why I’d love to one day meet him.

The Medical Quack – Barbara Duck has always been a good friend to me. I’ve always hated her blogger design, but she seems to like it. Barbara and I first met on the EMR Update forum (where I really cut my EMR teeth), and she’s always been a kind, but passionate lover of healthcare. I still remember how brave she was to be developing an EMR on her own (she’s since shut it down).

Candid CIO – Still one of my favorite blogs to read. I think Will is one of the smartest hospital CIOs that I’ve met. He has great insight and a great view of his job as CIO. Plus, I love a hospital CIO that’s willing to take time to blog.

The Healthcare Blog – I’m not sure if this one started a little after mine or if I just didn’t find it until after. Although, it was one of the early ones and had great writers like David Kibbe and Vince Kuraitis. Plus, the always interesting Matthew Holt. It’s not exclusively healthcare IT (which is my love), but a huge portion of it is about health IT.

When I think about all of these blogs that have been there since the beginning it’s fun to see so many of them still around and blogging today. That’s a special commitment. Although, I also realized that when it comes to blogs, you might call us the Legacy EMR bloggers. To use my own analogy, are we the Jabba the Hutt EMR bloggers? In some ways I think I am. The question is whether a blogger does better with age like a fine wine or if it just rots and gets thrown out.

The Cult of Cool in a World of EMRs

Posted on May 22, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I realized two things the other day. Things I’ve been in denial about. Things I just couldn’t bring myself to admit to anyone else in the world of healthcare IT.

I’m old, and I’m not cool.

I’ve hidden these two flaws fairly well, but a recent high-profile tech acquisition has forced me to let the cat out of the bag. I’ve never used Tumblr (or Instagram for that matter), and I can’t force myself to close my Yahoo! account. I’ve checked that email address for the last 12 years. I fondly remember when my boyfriend/husband set it up for me in an Internet café in Amsterdam. He had been demanding for some time that I rid myself of my @uga.edu address. Graduation was looming and it was time for something more adult, more cool.

My how times change. It’s people like me, apparently, that are holding Yahoo! back and what prompted it to purchase Tumblr. As I’m sure you’ve heard (especially if you’re not cool like me and listen to NPR all the time), it paid over a billion dollars to acquire the micro-blogging site in an effort to get its ads in front of Tumblr’s 100 million users – most of which are young, cool and influential amongst their peers. It’s a demographic most marketers can only dream about having dropped in their laps. Now it’s up to Yahoo! to not screw it up, as CEO Melissa Mayer so succinctly said during a recent conference call.

News of the acquisition got me wondering, are EMRs cool? I think there’s certainly a hip factor around certain parts of healthcare IT. Openness, innovation, mobile health, social networking and bow ties seem to be in right now, but I’m not sure I’d go so far as to call any one particular EMR cool. Though athenahealth and Practice Fusion jump to mind as fairly cool from a branding perspective. Epic certainly seems to have won the word-of-mouth game, so perhaps it can be lumped into the cool category as well.

Perhaps the fact that only three brands come to mind is a good thing. I hope that most companies are spending more time focused on development than branding. Surely players in this most sacred of spaces would never acquire one company over the other purely to latch onto a coolness factor? I could understand the business acumen behind the decision to acquire a start up in the “hopes of gaining an edge in growth,” which is how a recent Wall Street Journal article described the Yahoo!/Tumblr transaction. Goodness knows there’s no shortage of start ups in healthcare right now.

How do you define cool in today’s world of healthcare IT? Is it about technology, branding or some unidentifiable “je ne sais quoi?” Share your comments with me below.

John’s Editorial Note: If Jenn’s not young and cool, then the rest of us are in real trouble.

Balancing EHR Change vs Train

Posted on May 21, 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.

I was talking with Heather Haugen from The Breakaway Group (A Xerox company) today and in our discussion she used the word “train”, but I heard the word “change”. I always love a good play on words and so it was interesting for me to consider the difference between change and train in an EHR implementation.

Every EHR implementation I’ve been apart of walks a fine line between users wanting the EHR software to change versus the need for an EHR user to change. One of the most common phrases out of a doctor’s mouth during an EHR implementation is, “Why did the EHR vendor implement that feature like this? Did they not talk to a doctor? This makes no sense.” We’ve dug in previously to the concept of EHR vendors consulting doctors during their EHR development so we won’t go into that further now. Every EHR vendor consults doctors, but no two doctors practice alike. So, it’s normal that every doctor would wonder why certain features are implemented the way they are implemented.

When faced with this issue, the doctor is faced with an important decision with two options. The first option is to work with the EHR vendor and convince them to change how their EHR works. In a large hospital EHR vendor situation, this can be almost impossible. Plus, even if that EHR vendor does like your suggested change it’s going to take months and sometimes years before that change is implemented in the EHR software, tested, and released all the way to you the end user. Yes, these changes can go faster with a SaaS EHR, but it still will likely take months before the change reaches the end user.

In some cases, you can wait for the change to be made before using that EHR feature. However, more often than not a doctor is going to have to train on how the EHR vendor has implemented the feature. This highlights to me why having great EHR training is so important. Sure, many of the things in an EHR will be intuitive, but great EHR training is still always beneficial. EHR software is too complex to just pickup and use. Plus, even if you can use the basic EHR features, good training points out the ways to optimize the EHR workflow.

Most doctors don’t understand why various parts of an EHR workflow can’t be easily changed. They just think change should happen easily. Ironically, the doctor then proceeds to resist any change to how they want to work.