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Costco Begins Selling Allscripts EMRs To Doctors

Posted on December 30, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A little earlier this month American Medical News had an article about Costco selling EHR software. This doesn’t come as a big surprise since Walmart had been selling an EHR out of Sam’s Club for quite a while. Although, that program was discontinued shortly after the initial launch. Here’s a piece of the Allscripts MyWay EHR offering in Costco for those that missed it:

Costco has partnered with Etransmedia Technology to sell Allscripts MyWay EHR and practice management systems at Costco stores nationally. The store hopes physicians looking to collect incentive money for meaningful use of electronic medical records will take advantage of the deal.

Costco executive members can implement the integrated EMR/practice management system for $499 a month. For nonexecutive members, the price is $599 a month. The pricing is based on a 60-month contract, according to costcoehr.com, a website Etransmedia launched to promote the deal.

The Allscripts MyWay system offered by Costco is an integrated, Web-based EMR and practice management solution that includes e-prescribing, electronic claims and a patient portal. The monthly fee includes maintenance, support and hosting as well as online training. Allscripts advertises the EMR and PM systems separately on its website for $375 and $225, respectively, per full-time physician, per month.

Costco is not offering a deep discount for the systems, but the company said it is “simplifying the buying process” by offering a product it “carefully” selected.

Despite this having been done before, I’m still seeing a lot of people on social media sites that are asking why Costco would offer an EHR. The answer to me is simple: marketing. I remember reading the story of a practice that had gone through a thorough EHR selection process that was de-railed thanks to a Sam’s Club ad about EHR software. Something’s wrong with that practice in my opinion, but the reality of EHR sales is that the sale often hinges on the littlest thing. Even if that little thing is a Costco ad.

Yes, Costco EHR just doesn’t make sense, but when you consider it as a relatively inexpensive way to market your product to doctors, maybe it’s not that strange. Although, I could think of other more targeted ways to market EHR software.

While you’re at Costco purchasing your EHR, be sure to pick up a pack of those Fat Boy ice cream sandwiches. I’m sure they’ll make a great addition to your EHR implementation. It’s amazing what food will do to enhance staff morale.

Obstacles To Using Tablets As EMR Front Ends

Posted on December 16, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Not long ago, I recently posted an item on HospitalEMRandEHR.com discussing how one hospital dropped plans to distribute iPads as front-ends for its Cerner EMR.  Doctors at hospital, Seattle Children’s, gave the iPad very bad reviews as an EMR-connected device, in part because they felt that Cerner’s system was too hard to use via a Safari browser.

Since then, a few readers have commented on the story, and interestingly, they’ve offered more nuanced feedback on what works (and doesn’t) in deploying a tablet as an EMR device for clinical use, including the following:

* Deploying the iPad initially offers a patient “wow factor” — in other words, it may make providers look hip and up-to-date technically — but that doesn’t last very long.

* Even a well-designed, tablet-native tablet app may still be frustrating for clinicians to use, given the high volume of information they need to enter. (Paging through a dozen screens is no fun.)

* When choosing a tablet, be aware that the physical performance of the tablet (especially the touch screen) can be a big issue.  If clinicians “touch” and the screen doesn’t respond, it can throw them off their stride.

It’s hard to argue that hospitals (and medical practices) should take mobile access to EMRs seriously. And anyone here would know, most organizations are.  After all, now that health IT industry is looking hard at mHealth, smart new ways to use mobile devices in care seem to be springing up daily.

But before you dig too deeply into your mobile strategy, you may want to hear more clinicians on how their mobile EMR usage is playing out. Call me a curmudgeon, but it seems to me that it may still be too early to invest big bucks in a tablet for mobilizing your EMR just yet.

Don’t get me wrong: I’m convinced that someday, every doctor will enter and access patient data via some sort of mobile device. But it seems that there’s some fairly important technical issues that still need to work themselves out before we can say “this is how we should do it.”

OccupyYourEMR! – An Idea Whose Time Has Come

Posted on November 22, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Note:  The following is not to be taken at face value, exactly — I’m not literally convinced that it’s time for a revolution — but you might see a point or two here that are worth considering further.

Doctors, are you sick of having an EMR pushed down your throat by administrators and IT leaders that don’t care how disruptive or painful the change may be?  Do you feel like your complaints and concerns aren’t being heard?  Are you actually afraid a patient will be hurt someday because of the EMR’s limitations?

Well, I say it’s high time you get radical and OccupyYourEMR!  Get in there and resist until your (absolutely critical) voice is being heard.

If you don’t, you know you’re going to be steamrolled into using a platform that’s awkward, ugly, inflexible and slow — in short, a system only the IT admin and hospital board who funded it could love.   Maybe you’re not ready to stop working, but what if you refused to log in?

As things stand, you have little to gain and a lot to lose by blindly kowtowing to EMR adoption demands.

Hey, if Hospital X installs an EHR and it seems to work, the CIO and the CEO and the board of directors look like geniuses. Some of them will probably get big bonuses if everything falls into place just right.

You, on the other hand, will be lucky if the new system doesn’t cut your work pace in half, confuse you and make charting a painful chore. Oh, and if things really go badly, you’ll harm or kill a patient because you didn’t read the EMR right.  Of course, the hospital will be right there beside you offering the best legal defense money can buy, right? (Uh, not really…)

Yes, there are some stories out there about EMRs that actually improve patient care and make doctors’ lives easier, but let’s face it, there’s a reason we don’t publish a ton of those here (or on sister blog Hospital EMR and EHR).  I’m not suggesting that all EMR rollouts are a mess, but few are a walk in the garden either. And it’s more common than you might think for a provider organization to go through a second or even a third installation before everything works.

Hey, don’t misunderstand me, I still believe EMRs are going to be a positive force over the long term.  In the mean time, though, some clinicians will be casualties — either becoming burned out by new work expectations, hating the new process or even making dangerous mistakes. Don’t be one of them.

Demand an EHR that helps your workflow, helps you provide better patient care, makes your life better, and lives up to the expectations the EMR salesperson made. An EHR that does those things will be welcomed by almost all doctors and other staff.

Epic, Cerner Best For ACOs? Say What?

Posted on September 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I don’t know about you, but I’m not exactly sure what an Accountable Care Organization is. In fact, I’m betting nobody is — there’s a bunch of harrumphing and throat clearing out there, but I haven’t seen any crystal-clear descriptions out there.  Shall we say that ACOs are more honored in the breach than in the observance and leave it at that?

Now, we come to the puzzling part of this piece. If nobody’s managed to define an ACO clearly, how can any particular EMR be a better ACO tool than another?  We’ll have to ask KLAS about this one, since they’re the ones that discovered this “fact.”

Today, KLAS announced that it had interviewed 197 providers at 187 organizations to see how ACOs are forming up. A third of the respondents said that they were pursuing a formal Medicare ACO designation, and the majority were felt ACOs were the future, KLAS reported.

Sure, considering that ACOs are just risk-taking organizations with a capitated feel, some people already have a sense of what to expect. But throw an EMR into the mix and we’re in new territory — hopefully good territory, but new nonetheless.

So, tell me how providers know that Epic and Cerner are the most ACO-ready? Apparently, respondents believe that Cerner already has many of the IT pieces needed to run ACOs; moreover, they say Cerner is working closely with providers interested in the ACO model.

Survey takers also gave a nod to Epic, which they see as being close to ready (though behind in analyics and ability to share data with non-Epic users).

Wait a minute — let me get this straight.  Respondents know Cerner has the right pieces, even though the ACO doesn’t exist yet?  They like Epic, even though it doesn’t share data outside of its walled garden?  KLAS is kidding, right?

At this point, I’ll be kind and say that Epic and Cerner users are a bit brainwashed, which I too might be if I’d spent the kind of money those folks have on an EMR.

But the voice in my suggests that KLAS might have had its finger on the scales just a little bit. I will not publicly state that Allscripts, CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens scored worse because they didn’t pay for play…but something sure isn’t right here.

 

 

 

Social Media and EMRs: Worlds Apart?

Posted on July 24, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Over the last year or two, a growing number of healthcare providers and organizations have gotten involved with social media. There’s a great deal of discussion underway in social media networks on how these new new tools can improve patient care, foster better communication between clinicians and even help patients manage their own care more effectively. (If these topics interest you, do a search on the Twitter hashtag #hcsm, and you’ll find lots of interesting content.)

As this discussion grows richer, a small number of healthcare social media innovators are beginning to discuss how to blend the strengths of social media with the power of EMRs.  At first blush, the two might seem worlds apart — one a database with with a nifty UI (we hope!) and the other a set of disarticulated, freewheeling communication channels.

One of the neatest visions I’ve seen of how this might work comes from pediatric gastroenterologist Dr. Bryan Vartabedian, who blogs on social media and medicine at 33 Charts.

Late last year, Dr. Vartabedian offered a detailed vision of an EMR-based “digital dashboard” which would allow doctors to slip easily between social discussion, content and clinical data. The key seems to be that the EMR would handle everything: it would incorporate social media tools, securely log communications, trigger related content and more.

But how long will it be until EMRs include functions like these?  Well, the general consensus seems to be “I wouldn’t hold my breath.”  Consider these comments from Josh Herigon, MPH, writing for the social media/medical blog KevinMD.com.

Although I dream of the day when we have a system like Dr. Vartabedian’s vision, I am not very optimistic such a system will come to fruition anytime soon…I would be satisfied with truly interconnected EMR systems (i.e.–I can pull up any patient’s chart from any hospital or clinic and see their entire recorded medical history), the elimination of pagers and subsequent replacement with secure smartphone communication systems, widespread use of tablets at the bedside that update the record in real-time so I can finish notes at a workstation, and some level of integration of Facebook/Twitter-like communication within care teams.

I’m not surprised that people are skeptical about linking EMRs and social media together.  While creating the interfaces Dr. Vartabedian describes in his article wouldn’t be a big deal technically, it would represent a big change in how vendors thought about their product. After all, a comprehensive system which juggles both social media and patient data is a much different deal than a patient database with some templates and analytical tools layered on top. The idea of making this kind of shift could give both programmers and vendors a bad case of the vapors.

On the other hand, Dr. Vartabedian is far from the only physician who’s passionate about making better use of social media. If healthcare social media fans can bring more colleagues on board — and slowly but surely, they’re clearly succeeding — EMR vendors will be forced to respond.  Having sat in on many “health 2.0” chats, I can tell you first-hand that there’s a lot of excitement about social media in medicine out there. I wouldn’t be surprised if evangelists defy critics’ expectations and turn social media into an everyday clinical tool.

Is This Failure Really Necessary? Another HIE Closes Its Doors

Posted on July 22, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For several years, I’ve been watching health information exchanges struggle to birth themselves. Despite ongoing support from state and local governments, HIEs continue to fade away, few having found a business model that works. And no workable business model seems to be on the horizon yet, either, despite efforts by thousands of providers to keep their HIE afloat.

This week, I was sorry to read about the death of yet another HIE.  CareSpark, a Kingsport, TN-based network which has been in existence for six years, announced on July 11th that it would be ceasing operations.  CareSpark, whose age makes it almost a young adult in HIE years, holds records for 1.28 million patients.

According to a piece in FierceHealthIT, CareSpark was forced to close because it couldn’t come up with a viable plan to sustain itself.  The group’s leaders had hoped to move from a grant-supported non-profit to one-funded by payments from subscribers, but apparently, they just couldn’t attract enough cash to survive.

The group began its final descent in March, when Health Information Partnership of Tennessee pulled federal funding from CareSpark.  The closing leaves 38 participating healthcare organizations in the lurch.

Given you don’t have a mature EMR if you can share health information freely — at least according to HIMSS Analytics — you’d think that providers would finally be ready to dish out enough money to support their local HIE.  But apparently, they aren’t.

The question is, why?  Do hospitals and medical practices think of HIEs as “nice to have” rather than “need to have”?  Do providers only kick in money when they can control the whole exchange (such as linking up hospitals within a single chain)? Have any of them done a cost/benefit analysis which suggests HIEs *aren’t* a good investment?

All I know is that if 38 providers spend six years building up trust, it doesn’t make much sense to cheap out now, especially if it shuts down critical linkages between their EMRs. I’d really like to know why they don’t want to pay for this. Don’t you? After all, it’s about time we figure out what kind of HIE model does work.

Top Three EMR Trends That Don’t Make Sense

Posted on July 18, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

So, from the Department of Human Perversity, here’s my list of current EMR trends that don’t make a whole heck of a lot of sense. (I know, it’s easier to complain than to actually be out there fixing things, but hey, being a critic is what I do best!)  In no particular order, here you have ’em:

*  EMRs Are Expensive, But Free Ones Are Bad:  OK, OK, before I have our friends at Practice Fusion on the horn telling me I’ve got it all wrong, yes, I realize that the free, Web-based EMR market has legs. But too many folks still seem convinced that TANSTAAFL (there ain’t no such thing as a free lunch).  OK, I admit that sometimes TANSTAAFL does apply, but in this case, with free and cheap EMR options available, where’s the hard-line resistance coming from?  For non-techies to be afraid of Linux — at least in its early days of commercialization — this, I get. But insisting on paying double for the privilege of getting an unwieldy system that’s a pain to upgrade?  Not so much.

* Let’s Keep Our Paper Records Forever:  So, as I’ve noted here before, some hospitals expect to store paper records for five years or more going forward, including some with mature EMR installationsin place. Keeping paper charts in play is certainly understandable from an emotional standpoint. Who wants to give up their way of life?  And who knows what will happen if your EMR balks, gets junked and loses vendor support, displeases one of your key physicians, gets hit by a bus or…whatever (fill in your nightmare scenario).  All sarcasm aside, this is obviously a very challenging transition. But if you’re going to go swimming, it helps to actually immerse yourself in the water. Besides, paper and electronic medical records largely aren’t compatible anyway, so what’s the point of maintaining both?

* If Our Templates Don’t Suit You, You Can Always Crawl Under A Rock:  I’ll admit, I started out a bit skeptical that specialty EMRs were a big deal. After all, I reasoned, just how different would the underlying data structure and workflow for a cardiology and a psychiatry practice be?  Actually, a lot, I’ve come to find out. In fact, I’ve come to realize that most EMRs aren’t flexible enough to suit two different medical practices within the same specialty.  Sure, vendors offer customizable templates, but far too often, using them is so painful that staffers and doctors largely give up. That’s not only non-good, it’s dangerous, if it leads to clinicians working ineffectively.  Now, I realize that enterprise software vendors in and outside of healthcare will force the customer to do the adapting if they can get away with it. But the big boys’ indifference seems particularly pointed in this case.

I have many other EMR industry pet peeves to share, but to my mind, these are  having the biggest effect on the process of EMR adoption.  So, do  you think I’ve hit the real pain points?  Do you have others to share?

 

Mayo Developing Tools To Extract Medical Data From All EMRs

Posted on July 17, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Here’s some interesting and potentially important news. According to some recent news items, it seems that Mayo Clinic investigators are putting the finishing touches on a suite of tools which can identify and sort medical data contained in any electronic medical record.

Mayo investigators are working under a federal grant, the $60 million Strategic Health IT Advanced Research Projects (SHARP) program, which is funded by the ONC.

According to a piece in Government HealthIT, the researchers have used natural language processing tools to isolate health data from about 30 digital medical records of patients with diabetes.  So far, so good. When the extracted data is run through specialized systems developed with IBM’s Watson Research Center, the 30 patient records “explode” into 134 *bilion* individual pieces of information, Government HealthIT reports.

Unfortunately, none of the sources I have explain what specific data pieces make up this total, which sounds extremely high to me. If we’re talking about just 30 patients, it’s hard for me to imagine that mundane details of care represent even multiple thousands of data points, unless you’re dealing with decades of care. (Perhaps the information involved includes the coding needed to extract the data — readers, can you clarify this for me perhaps?)

While I can’t testify as to how realistic the Mayo researchers’ claims are, I have to think that if they’re on target, something very big is in the works.  After all, to date I’ve heard little of tools that can effectively, fluidly extract clinical data from an entire EMR-based patient chart regardless of format or data organization. Concepts like natural language processing are far from new, but it seems they haven’t been up to the job.

Not only would  such capabilities allow virtually any set of institutions to share data, a giant leap in and of itself, they would also allow providers to do unprecedented levels of clinical analysis and ultimately improve care.

On the other hand, it’s not clear how practical this approach will be. If it only takes 30 records to generate that much data, just imagine how much data a single mid-sized hospital would have to wrangle!  If I’m reading things right, this technology may remain stuck at the research stage, as it’s hard to imagine most institutions could manage terabytes of new data.

Still, there’s clearly much to learn here. I’m eager to find out whether Mayo’s SHARP technology turns out to be usable in everyday clinical life.

 

 

Are EMRs And Paper Records Incompatible?

Posted on July 15, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I just caught a blog post by the indefatigable Fred Trotter (a high-profile Open Source guy focused on HIT) which raised an important issue.  In his article, Trotter argues credibly that once a healthcare organization implements an EMR, its records are more or less incompatible with standard paper records.

Trotter cites the troubling case of two primary care groups which, despite the using same major EMR system, can only share data by printing out massive paper transcripts of a patient’s electronic record.

Apparently, each have a custom version of the system in place, which means that the two groups couldn’t share data directly. So when a patient from Practice A moves to Practice B, Practice A’s only option is to generate what — from a photo included in the article  — looks like thousands of pages of data.

Not only are such paper printouts awkward to store and manage, they’re painfully difficult to use. While traditional handwritten records provide a familiar, and relatively concise, source of medical data, this blizzard of paper could actually bury critical information.

After all, while the data might make sense when access via the EMR’s digital templates, doctors may not know where to find what they’re looking for when confronted with the print equivalent of a massive Excel spreadsheet.

Not only that, when Practice B scans this paper monster into its system, the problem just gets worse. When caring for the patient, B’s doctors will doubtless begin entering data into their own EMR system, piling structured data on top of incompatible scanned data. How clinicians will figure out what’s up with the patient is a mystery to me.

As commentors to Trotter’s item noted, the two practices could probably have shared a summary in Continuity of Care Document format. However, unless practices are willing to make do with a summary over the long term, they’re likely to confront paper printouts for quite some time.  Not a pretty picture, is it?

Hospitals Slow To Convert Paper Records, And May Not Know How To Manage Them

Posted on July 13, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Anyone who’s been around the HIT block a few times knows that the conversion from paper to digital records is going to be much uglier than the public thinks.  This new study from vendor Iron Mountain, however, offers some details that surprised even a cynic like myself.

The study, which surveyed 200 health information pros, asked them how they were doing with scanning paper medical records and how they expected to use the paper archives in the future.

One of the most interesting findings from the study, in my  view at least, is that while 70 percent of hospitals are claiming Meaningful Use Stage One rewards, 78 percent expect to use paper records for as many as five years more.

The study also found that hospitals planned to spend as much as $100 million just on the scanning process, a number which rocked me a bit even given the size of the  problem.  Iron Mountain researchers concluded that the costs are running high, in part, because institutions are using many different approaches to digitizing medical information.

Other data points from the study:

* About half of hospitals said they’d scanned what they needed to scan and were within budget

* Twenty-three percent of hospitals  said they were within budget for scanning, but had a backlog of records left to scan

* Once they scan their paper records, 58 percent of hospitals plan to shred  them, while 38 percent will store legacy records in an onsite room or offsite facility.

* Fourty-four percent of hospitals “are not explicitly measuring the effectiveness or productivity of their scanning process,” researchers concluded.

Though it’s interesting on its face, the study summary raises lots of questions.

For one thing, what metrics are 56 percent of hospitals are using to measure scanning effectiveness? Are we talking about accuracy of OCR performance, employee time invested, speed of scans, ease of retrieving stored data, or other measures?

How are hospitals with active EHRs keeping track of which documents have been scanned, which haven’t, which have been pulled and are in queue to be scanned and which have been reviewed for quality?

How will the 38 percent of hospitals planning to store paper records going to manage those paper records? Will staff have the ability to access paper records in a timely way if they need them?

I have no doubt that decent IT solutions exist to handle these issues. In fact, given that the banking business still exists, we know that one can move an industry from paper to digital records without a complete collapse. But as both an analyst and a patient, I wish I felt more confident that this particular transition is going smoothly.