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Hospital Mergers Complicate EMR Transition

Getting an EMR up and running in a hospital or health system is complicated enough. But managing EMR implementations in the midst of hospital mergers is even more difficult.

Like it or not, though, hospital CIOs are increasingly facing the likelihood that they’ll be facing a merger in the midst of their EMR rollout, notes a new piece in the Wall Street Journal. With reimbursements from both Medicare and private insurers falling, hospitals’ margins are growing perilously thin, and the pace of hospital mergers is likely to increase, according to a March report by Moody’s.

Right now, for example, two of New York’s biggest hospital chains — NYU Langone Medical Center and Continuum Health Partners — have agreed to discuss a possible merger. Continuum CIO Mark Moroses is in the process of moving his chain of hospitals to its GE Centricity EMR, in a move which will allow the chain to collect $20 million to $30 million in Meaningful Use incentives.

If the merger between Langone and Continuum goes through, Moroses will have to stitch together dozens of billing,  procurement and patient care systems over the next few years, the WSJ notes. But more than that, the hospital chains will have to synchronize their clinical information management, a formidable job which, as Moroses says, leaves no room for error.

It’s not just systems integration that merging systems will face, however. As the WSJ piece notes, when North Shore-Long Island Jewish Health System took over Lenox Hill Hospital in 2010, the systems’s CMIO Michael Oppenheim had to bring Lenox Hill’s data to a new version of its Allscripts EMR.  The system used currently by Lenox Hill is an old one which isn’t certified for Meaningful Use.

Ultimately, hospitals’ urge to merge makes sense on a lot of levels. Given their tremendous capital costs (including EMR spending) it only makes sense to achieve economies of scale.  Unfortunately, the commonsense desire to save money and be more efficient is going to subject HIT leaders to an even rougher ride then they might have expected.

June 14, 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 @annezieger on Twitter.

Meaningful Use Attestations With Faked Vendor Info?

When providers attest to Meaningful Use Stage 1 compliance, they have to identify the vendor whose EMR they used. But what if a large number of providers were faking this step in an effort to get incentive money that they don’t deserve?  That would be a lot of fraud, no?

Well, according to one vendor CEO, this could be happening on a large scale. Mike Jenkins, CEO of cloud-based vendor BuildYourEMR.com, reports that after going over CMS data on Meaningful Use, he found that a whopping 74 percent of providers who attested to using his company’s technology were not his customers.

Jenkins points out that if fraud were actually this common, a full $5.4 billion of the $7.6 billion paid out to providers would have been paid out in error. He admits that there could be something wrong with the CMS data, or that providers selected his company’s product name by accident, but concedes that it’s possible attestation fraud is more common than we think.

I’m not telling you this to suggest that the Meaningful Use program is riddled with fraudulent activity.  I’m doubful, in fact, that even a fraction of providers would dare incur the wrath of Medicare by making such a traceable error, much less consciously try to rip the incentive program off.

This does suggest, however, that more healthcare IT people should take a look at the CMS data and go over it themselves, especially EMR vendors. While there may not be a hailstorm of fraud going on, something may be seriously amiss in how CMS collects data or how providers report on their attestation.  It’d definitely be good to get ahead of any pending troubles with CMS, for sure.

April 17, 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 @annezieger on Twitter.

ONC Plan Focuses On Health IT Safety

The ONC has decided that it’s time to move health IT safety up to the next level, proposing a plan that would standardize the way health IT safety incidents are reported and make it easier to report straight from an EMR. And brace yourselves, vendors: this could include changing the EMR certification process to include the ability to make such reports easily.

The agency’s Health IT Patient Safety Action and Surveillance Plan is designed to strengthen patient safety efforts, including patients, providers, technology companies and healthcare safety oversight bodies in the mix. The idea, not surprisingly, is to use health IT to make care safer.

The ONC’s key objectives include the following:

*  Making it easier for clinicians to report patient safety events and risks using EMRs

Right now, it’s not exactly easy for clinicians to create a safety event report when something goes wrong in their use of an EMR, and the data they do sometimes produce isn’t easy to work with or compile.  ONC is proposing using certification criteria to make sure that whenever possible, EMRs make it easy to report safety events using the Agency for Healthcare Research and Quality’s standardized Common Formats.

*  Getting health IT developers to support patient safety and safety reporting

Within 12 months, the ONC plans to create a code of conduct — working with professional groups and health IT developers — which will hold developers accountable for:

– Creating usable, safe designs for products and adverse event reporting
– Working with a Patient Safety Organization to report, aggregate and analyze health IT related safety events
–  Scrapping practices that discourage provider reporting of safety events, such as limits in nondisclosure clauses and intellectual property protections
–  Participating in efforts to compare user experiences across different EMR systems

There’s plenty more to consider in this report, but I’ll leave you with these details in the hope that you’ll read it yourself.  As you’ll see in the introduction, you have until February 4th to comment on ONC’s plans. I hope plenty of readers do — this is important stuff.

January 2, 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 @annezieger on Twitter.

Pediatricians Find EMRs Lacking

While there’s no lack of specialty EMRs out there, it seems that pediatricians feel undeserved anyway. In fact, a new study suggests that there are five functions pediatricians look for in EMRs which are seldom found in a single system.

Almost half of pediatricians have adopted EMRs (48.5 percent), and 61.7 percent of doctors in internal medicine/pediatrics, according to a report in American Medical News.  (The data was drawn from marketing research firm SK&A, which does ongoing surveys on EMR adoption and use at 250,000-odd practices nationwide.)

The study, which appears in this month’s issue of the journal  Pediatrics, reports on a random survey of 646 postresidency pediatricians done in 2009 before the MU incentive program began. At the time, only 3 percent were using an EMR that they considered fully-functional and supportive of their specialty.

The authors say that pediatricians need five key features in place to consider an EMR complete. These include tracking of well-child visits, support of growth chart analysis, immunization tracking, immunization forecasting and weight-based drug dosing. Unfortunately, Meaningful Use standards  are nowhere near addressing the entire bundle of functions, they note.

So, are there any solutions for pediatricians which have emerged since the study survey was done? Certainly, there are scads of EMRs out there being marketed as pediatric EMRs. However, at first glance at least, most of the market for pediatric EMR solutions seems to be general  purpose systems offering pediatrics-specific templates.

On the horizon, however, there may be a glimmer of hope. Apparently, the Agency for Healthcare Quality and Research has designed a model children’s EMR which includes a list of child-specific functions, and ONC anticipates including these features in future stages of the EMR certification criteria.

In the mean time, it looks like pediatricians face the need to either work with (arguably) inefficient systems or customize systems on their own. Neither possibility would sound good if you were a pediatrician, would it?

December 10, 2012 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 @annezieger on Twitter.

CMS Needs To Tighten Up Meaningful Use Procedures, OIG Says

It looks like members of Congress aren’t the only ones finding fault with how CMS handles Meaningful Use incentives. In fact, HHS’s Office of the Inspector General has concluded that CMS needs to do more to verify that providers have indeed met MU standards both before and after payments get made.

As the OIG notes in its new report, CMS estimates that it will pay out $6.6 billion in incentives between 2011 and 2016. As things stand, the payments will be based on data self-reported by professionals and hospitals. To get a sense of how well this method is working, the OIG reviewed CMS’s incentive program oversight for 2011, as well as analyzing the self-reported data and auditing the agency’s planning docs, regs and guidance for the  program.

What did the OIG find?  Researchers concluded that CMS faces obstacles to overseeing the EMR incentive program which could end up with its paying providers and hospitals that haven’t fully met Meaningful Use requirements.

More specifically, the OIG concluded that CMS hasn’t put strong prepayment safeguards in place, nor has it good mechanisms for auditing incentive disbursements postpayment.  Moreover, ONC requirements for EMR reports might be getting in the way of more accurate incentive payment processes, the report said.

The OIG’s recommendations include having CMS get and review supporting documentation from selected hospitals and professionals before it cuts Meaningful Use checks, a step CMS rejects as imposing too big a burden on providers and slowing the payment process too much.  (For the sake of providers that need timely checks, let’s hope it stays that way.) The OIG also recommended that CMS  issue specific examples of documentation that can be used to support MU compliance.

Meanwhile, the OIG would like to see ONC  change certification requirements for EMRs to make it more likely that they can produce reports for yes/no Meaningful Use measures where possible. It would also like ONC to improve the certification process for EMR technology to make sure EMRs generate accurate reports.

For the most part, the  OIG’s recommendations seem reasonable, if not capable of being done overnight.  But I’ve got to agree that auditing incentive payments before issuing them would throw a serious kink into the process. Let’s hope the OIG and CMS compromise on something reasonable here.

December 4, 2012 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 @annezieger on Twitter.

EHR Vendors Using EHR Certification Excuse

As most of you have probably figured out by now, I’m not really a fan of EHR certification because I believe there is very little value provided by EHR certification. An interesting additional problem that comes from EHR certification and meaningful use has to do with how EHR vendors are using this as an excuse for why their EHR sucks doesn’t work the way doctors want it to work.

Don’t just think that I’m making this idea up. I first thought about this idea when a doctor wrote me about his experience with an EHR vendor that used EHR certification as an excuse for why their EHR software’s workflow was terrible.

The interaction went something like this:
Doctor: Why do I have to do these extra 5 clicks?
EHR Vendor: That’s required by EHR certification.
Doctor: That provides no value to the care I provide a patient.
EHR Vendor: Sorry, we have to do that for EHR certification.
Doctor: What about this other prompt I get in your EHR? Why does that come up and disrupt my workflow?
EHR Vendor: That’s another EHR certification and meaningful use requirement.

You’ll notice that I made the complaints generic, because they likely could apply to almost any measure in meaningful use and EHR certification requirement.

I’ve seen first hand the efforts that some EHR vendors have put forward to try and make sure that their doctors don’t have this discussion with them. You can be sure it takes a lot of time, energy, and skilled professionals to make meaningful use and EHR certification a seamless part of a practitioner’s EHR experience.

The problem is that many many EHR vendors just ran the EHR certification race and in an attempt to win that race they just slapped something together to meet the requirements. This I want to be the “first” EHR vendor certified mentality is causing many doctors to pay the price today.

Is it any wonder that many doctors look at meaningful use and are upset by the way it’s changing the way they practice medicine?

October 11, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Switching EMR and EHR Software

I’ve long been concerned about the challenge of switching EHR software. I’ve recently got into some discussions with people asking why EHR certification and meaningful use didn’t require EHR data portability as part of the requirement.

I’d forgotten that Jerome Carter had pointed out in a previous EHR switching post where HHS asked for comments on EHR data portability in the proposed certification rule for EHR (PDF) under the section “Request for Additional Comments”. Here’s his comment with the page number that addresses it:

John, this series of posts on changing EHR systems is interesting. The data issues that arise when switching EHRs can catch providers off guard. In reading through the proposed certification rules for EHRs, I found a section on data portability that you might find interesting. It is on page 13872.

Link: http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4430.pdf

It’s an interesting section to read. The key is that they acknowledge the need to have some EHR data portability if you’re a doctor. Then, they look at these 4 questions:
1. Is the consolidated CDA enough?
2. How much EHR data do you need to move to the new EHR?
3. Could they start with an incremental approach that could expand later?
4. What are the security issues of being able to easily export you EHR data?

These are all good questions. I’d answer them simply:
1. Is the consolidated CDA enough?
No, you need more.

2. How much EHR data do you need to move to the new EHR?
All. Otherwise, you have to keep the old EHR running and what if that old EHR is GONE.

3. Could they start with an incremental approach that could expand later?
I think they need to go all in with this. The consolidated CDA is basically an incremental approach already.

4. What are the security issues of being able to easily export you EHR data?
I always love to follow it with the opposite, what are the issues of not having this EHR data portability available? You do have to be careful when you can export all of your EHR data, but the security is manageable.

What are your thoughts on EHR data portability? I’d still love to find a way to help solve this problem. It’s a big one that would provide amazing value.

August 16, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Are All Meaningful Use Implementations Created Equal?

In reaction to my post discussing a physician’s enlightening reaction to meaningful use one commenter highlighted what I think is a really interesting question: Are All Meaningful Use Implementations Created Equal?

The interesting thing is that the doctors comments mentioned above essentially highlight his belief that meaningful use has caused EMR software to not reach its full potential. I’d even take it a step further and say that meaningful use and its sister EHR certification have done much to level the playing field of EHR software. Instead of doctors choosing an EHR based on usability, recommendations, features, functions, workflow, etc etc etc, they’re asking if the vendor is a certified EHR and can get them EHR incentive money.

A cynical view would be that doctors are now evaluating EHR software based on how easily that EHR software can get them EHR incentive money. While this may be the case for some doctors, my feeling is that it’s not a widespread pandemic problem.

We can all be certain that doctors are evaluating meaningful use as a major component of their EHR selection process. Every EHR vendor I’ve talked to has said this, so it must be true. Since meaningful use is a standard set by the government and certified EHR software requires a certain set of standards, does that mean that in that list of requirements all EHR software are basically equal?

The answer is an emphatic: NO!

I can assure you that some EHR software vendors have slapped in the meaningful use requirements as quick as they could get it in there. I’m sure that some rushed it just to be able to say they were the first. The first to what I don’t know. In many ways, being the first to be a certified EHR with meaningful use baked in could be considered a badge of shame. Instead, if I were a doctor I’d want an EHR vendor that took their time and implemented meaningful use in a thoughtful way that will be as seamless and non-intrusive as possible.

I still love what Conan Fong and Kyna Fong of ElationEMR said to me about meaningful use and EHR certification: We’re trying to strip out the EHR certification and meaningful use requirements as much as possible so that the doctor doesn’t even know she’s doing it. It just happens in the natural flow of her work. [Obviously not an exact quote since it was a couple years ago, but you get the gist.]

Compare that approach to an EHR vendor that just slapped in some features to meet the requirements without much thought of how that will actually impact a doctor. Indeed, not all meaningful use EHR implementations are created equal.

It still gets under my skin a little bit to think that how well an EHR implemented meaningful use becomes part of a physician’s EHR selection criteria. Something doesn’t feel right about that to me. However, I expect that those EHR who thoughtfully approached meaningful use and EHR certification also did the same with everything else in their EHR and so maybe that’s not such a bad thing after all.

April 4, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Meaningful Use Solidifies EHR as the Database of Healthcare

Earlier this month I wrote a post describing EHR as the Database of Healthcare. I believe this is a powerful and important thing to understand. It also led to some good conversation in the comments. As an entrepreneur I’m always interested to see the trends in the industry to hopefully better understand what is going to happen in the future. I think that this is one of those trends.

Just to make the case clearer, consider the effects of meaningful use on EHR software. Meaningful use stage 1 and EHR certification has already hijacked at least one EHR development cycle and you can be sure that meaningful use stage 2 and stage 3 will be hijacking another couple EHR development cycles. You heard me right. In order to meet the EHR certification and meaningful use requirements, most EHR vendors have to put a whole development team focused just on meeting those government requirements.

Meaningful use has codified EHRs into a box.

Instead of allowing EHR software to create innovative solutions it requires standards be met for storing and accessing info. Sure it also adds in security and tries to work towards interoperability, but those aren’t innovations that doctors want to see.

I expect many of the best healthcare innovators will build on top of the EHR base, not try and build the base again.

March 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Epocrates EMR Killed Immediately After Launch

Back in 2010, Epocrates had its EMR ducks in a row. The company, known best for a very popular smartphone-based drug interaction database for physicians, announced plans to release a mobile SaaS EMR.  While Epocrates was jumping into a market more crowded than a barrel full of monkeys, one could see where leaders might see an EMR as an extension of the relationship it already had with physicians.

Now, Epocrates leaders have said “oops” and announced that they were killing the product,  telling investors and the public that building the darned thing was distracting it from its core business.  It does seem that the company was struggling with the EMR rollout process:  it didn’t roll out its first-phase product until August 2011 and didn’t get its Meaningful Use certification until February of this year. But this is the first time I’ve seen a company kill a product at this stage of development, particularly in such a high-profile manner.

It must have been more than a bit embarrassing to make the announcement during HIMSS12 when, of course, companies traditionally kick off products they’re planning to sell vigorously. As Epocrates was making plans to dump or sell their EMR, the company’s CMIO, Tom Giannulli, MD, was pitching the company’s new iPad EMR to editors.

As Epocrates itself pointed out, there aren’t too many dedicated iPad EMR offerings out there. So in theory, this should not have been a waste of the company’s time.  On the other hand, with the iPad still a new frontier for EMRs, we still don’t know whether it will ultimately work as a platform of choice for physicians.  As we’ve previously discussed on this blog, the iPad seems to be a pretty good medium for reading data but a very awkward one for entering data. Whether that’s a fatal flaw remains to be seen.

Truthfully, this looks like a failure of execution from start to finish, rather than a product that couldn’t possibly work. But these are tough times. Even the best execution may not work; and if so, Epocrates was probably wise to fold its cards before further damage was done.

March 15, 2012 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 @annezieger on Twitter.