A lot has already been written about whether or not EMRs lead – directly or indirectly – to higher patient satisfaction scores, but I’ve yet to find anything on those scores being included in the patient’s record itself. The idea occurred to me this past weekend, as I was on the phone with a survey firm asking patient satisfaction questions on behalf of Kaiser Permanente.

The visit in question was routine and had gone well, so my ratings were high, and the call was quick. Would the doctor who had been involved ever see my direct responses? Do doctors see these scores in aggregate, or can they look them up by individual patient? Would they feel themselves more accountable if they could see how a patient rated their last encounter while looking at that person’ EMR?

I supposed it could go either way. A healthy, highly satisfied patient’s record would display high scores and vice versa. That person’s doctor could look at these scores before the next encounter to see what could be improved upon, what to keep doing, or what to start doing with other patients of a similar condition. I wonder  if the ability to view a particular patient’s satisfaction scores wouldn’t somehow make the doctor feel even more accountable for their patient’s health – if they’d have more “skin in the game,” so to speak.

Perhaps it could have a negative effect. Low satisfaction scores could lead to an emotionally charged appointment if a doctor doesn’t fully understand why the scores were given.

After my phone call, I did wonder if other health systems send out patient satisfaction surveys electronically, making them accessible via an email or a patient’s portal. The ability to respond digitally would seem to also enable the ability to make personal comments on the scores – something I was not given the option to do on the phone call. I’ve filled out paper satisfaction surveys from other providers, but don’t recall comment boxes being included. Come to think of it, I filled out the paper survey mainly because the hospital told me I had the chance to win a prize if I did so. I wish my phone survey had offered that incentive!

Patient satisfaction scores are important, of course, especially in this day and age of accountable care. I just wonder if they’re not being given enough transparency by hospital management. If doctors could see the good and the bad on a microscopic rather than macroscopic level, would they strive to produce better outcomes?

Let me know what you’ve heard or seen lately in the comments below.

I wrote a post a few months back called The Perfect EMR is Mythology that I think people took the wrong way. In that post, I’m not saying that doctors should lower their EHR standards just because it is the EHR product that is most accessible and easy to implement. I’m not saying that doctors should just take whatever EHR they see first. I’m not even saying that every doctor should adopt EHR.

It’s one thing to accept and use an EHR product that’s imperfect, but still improves your clinic. It’s another thing to accept a terrible product that makes your life miserable. Particularly when there are other EHR software out there that won’t make your life miserable. Something I’ve been seeing more and more from doctors is that they haven’t found the perfect EMR software that does exactly everything they could imagine an EMR to do, so they wait. I think this is a bad choice for many.

Yes, I do think that doctors should spend plenty of time doing proper due diligence before “marrying” themselves to an EHR system. They should absolutely find one that works well for their clinical situation. Physicians should absolutely have reasonable expectations for their EHR vendor and hold them to it. In fact, physicians should hold EMR vendors accountable for what that EHR vendor has committed to accomplish in the EMR selection process.

As I said in my previous post:
Don’t let the quest for perfection get in the way of incremental improvement. Perfection is more nearly obtained through many incremental improvement than giant leaps.

If a physician’s standard is a perfect EHR, then they’re going to be sorely disappointed. If their standard is improvements in their clinic, then there are EHR options out there that are well worth considering and implementing.

And Caesar’s spirit, raging for revenge,
With Ate by his side come hot from hell,
Shall in these confines with a monarch’s voice
Cry “Havoc!” and let slip the dogs of war,
– Julius Caesar, Act 3, Scene 1

If ever there was havoc in the boardroom of a health IT company, this is it. Over the last several days, chairman Phil Pead (bio still up for now), CFO William Davis and three board members unceremoniously and promptly departed the management team at Allscripts Healthcare (MDRX), a company which, it’s hard to argue, otherwise seems to have been on a reasonable course for the past year or so.

By the way, this seems to have been as much an Eclipsys purge as a board purge, as all of the departing members were with the company, which Allscripts acquired in September 2010 with “a vision for a Connected Community of Health.”

Within a few days, the Board announced that it had elected board member Dennis Chookaszian as Chairman. No word yet on which unlucky CFO will be hired to face the fires of investor displeasure over the stock’s performance (see below).

It’s bad enough when a chairman and three board members split — allegedly in support of now-ex chairman Phil Pead — but when your CFO leaves, a girl’s gotta wonder whether financial improprieties will turn up later. Now, let’s be clear, I’m not suggesting that there are ANY financial issues that I know of myself, directly, but it’s never a nice thing to see Mr. CFO shove off so quickly.

What we do know is that Allscripts was slapped with a suit in 2009 alleging the company broke federal securities laws when it went live with the latest version of its EMR. Current CEO Glen Tullman and now departed CFO William Davis were named as defendents. The  accusations in the 2009 suit seem to boil down to that Allscripts failed to let customers know that it couldn’t afford to install its Touchworks 11 software properly on customer sites.

It gets even better

And now, even more fun. Perhaps to contribute to the gladiatorial atmosphere, one of Allscripts’ largest shareholders demanded Monday April 30 that its chief executive Glen Tullman resign.  (If I were Tullman I’d say “the heck with that,” gather a group of investors and buy the darned thing out from under them. Mr. Tullman, go for it!)

Anyway, it seems that HealthCor Management LP, which owns about 5 percent of Allscripts outstanding shares, thinks execs have done a bad job building the value of the stock. The fund said the stock  is “being valued well below any reasonable acquisition price,” at its Friday close of $10.30.  Other investors seem to agree with HealthCor, as the stock went  up 7.73 percent to $11.10 at the close of trading on Monday April 30.

To make sure nobody panics, the company has hurriedly announced a $200 million stock repurchase  plan, adding to a plan announced a year ago which still contains $148 million for repurchase. That should do something to keep the stock from careening down a greased slide.

Why, oh why?

Now, to the real question. Why the big shakeup in the boardroom at a time when EMR/EHR companies are extremely vulnerable to market shifts and missteps? I can’t say I’ve found any concrete reason in my research, other than storied “differences of opinion over the direction of the company.”

The financials, while they could probably be much stronger, aren’t exactly pathetic. We’ve got a 5.1 percent profit margin, quarterly revenue growth year over year of 25.5 percent and a P/E (ttm, intraday) of 28.52.  The only obvious disappointment is the big drop in share price, which fell nearly 50 percent over the last 52 weeks of trading.

And in a somewhat ironic twist, it seems that Allscripts is touting some variant of the software Eclipsys had (Touchworks) when it first ran into SEC trouble.  Allscripts may not like the guys behind the technology, but it likes the technology for sure. (Actually, I’m eager to learn more what Allscripts is doing there — drop us a note on our contact us page if you have more information.)

P.S.  In the view of your friend and mine Mr. HISTalk, “No matter what explanations are provided, the casual observer might conclude that Glen (Tullman) staged a coup that cost the company four board members and its CFO at the worst possible time.” What do you think?

I heard about Pinterest maybe a couple of months ago and if my slow uptake of Facebook is any indication, I have a good two years to go before I add another website to the pantheon of websites I must check daily.

However some early adopters are already talking of how the healthcare world can make use of this site. I came across one such article today via the Healthworks Collective site where Mike Wilton shows us a bunch of different healthcare related Pinterest uses. Some doctors or hospitals are using Pinterest to market their services, one hospital is using Pinterest to request donations for children, yet others are targeting certain demographics (parents, cancer patients) by becoming their go-to resources on some topics.

Since I’ve sworn fealty to all things EMR, I went searching for EMR related boards on Pinterest, and I must say I was underwhelmed. I did come across one slightly interesting one called Healthcare Infofraphics that was the source of the widely pinned Top20 EMR Softwares pie-graph. You can also find other Healthcare IT Infographics.

I know if you’re related to EMRs, a) your world isn’t as interesting or visual as say cupcakes, or quilts b) Pinterest is relatively new (hell, you can’t just sign up, you need an invite to register). But, seriously, do you think people are going to find screenshots of your software interesting enough to pin to their boards and share with others? And yeah, don’t bother scanning the tri-fold handout that you shoved into people’s hands at the last tradeshow. It might have worked great on paper but it looks cluttered and unimaginative on Pinterest.

I’m going to offer some tips here for anyone with any Pinterest interest, but more so for EMR vendors:
- it’s still early days. If you’re not on Pinterest and none of your nearest competitors are there too, maybe you can increase your cool cache instantly by signing up and creating a much viewed board.
- Make us see things. Instead of reams of text, maybe we need one pic of a happy client, a speech bubble and a super short compliment.
- Play to Pinterest. It’s a highly visual site. So what works for you on FB or Twitter might not work for you here.
- Approach it sideways. Yes, you want to sell your product and make money. But if you answer questions that your target demographic typically asks, your content will probably get pinned a lot more.

- don’t be square. Dare to do something out of the box. I would prefer my cartoon strip slightly funnier but I give Dell props for this attempt at making an unboring visual about EMRs.

Or maybe you should wait out. Pinterest has a lot of buzz. But so did Myspace and Foursquare. I even wrote a cringe-inducing article on Foursquare back in the day.

Today I read about a very interesting project focused on improving relationships between physicians and patients. I suspect the concept would make some doctors’ skin crawl — anytime you’re asked to give up over control of information, it smarts a bit — but I suspect we’re seeing a glimpse of the future.

The  OpenNotes project, which is being conducted at Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center, lets patients review the notes, e-mails and phone calls primary care doctors make after their medical appointment. Patients access the information via a secure Web interface.

In July 2010, researchers published baseline findings prior to the OpenNotes kickoff in the Annals of Internal Medicine. Since then, the project seems to have attracted a lot of interest, with more than 100 doctors and 20,000 patients participating.   It’s also gotten a lot of support from foundations;  the group has received grants from the Robert Wood Johnson Foundation Pioneer portfolio, the Drane Family Fund, the Koplow Family Foundation and the Katz Family Foundation.

Wondering how participants feel about this level of medical intimacy? Check out the OpenNotes site, where you’ll find a video  offering impressions from patients and doctors on how they feel about their level of communication.  As you’ll see, OpenNotes volunteer patients seem to enjoy having a closer relationship with their doctor, and more importantly, feel empowered to comment or even contradict the doctor if they see something that seems to be out of line.

“You can look at the comments that Bob writes down and sometimes you agree with him and sometimes you don’t,” says one patient. “Sometimes we clash on it, but then we work things out.” (Note the familiar title “Bob” the patient uses to address his doctor, which I doubt he would have otherwise.) Sounds like a better working relationship than I have with most of my providers!

Of course, there’s always questions as to whether approaches like these would work outside the confines of a grant-funded, academically-minded group of institutions and doctors.  Certainly that’s hard to tell. But it seems clear that at minimum, something worthwhile is going on here that might force vendors to think about patient facing data more deeply.  I’m impressed by what I see here and hope that we continue to learn from these efforts.

I heard an interesting statistic a few days ago during a very informative webinar – “The Future of Meaningful Use, EHRs and Accountable Care” – hosted by Greenway Medical’s Justin Barnes. He shared a huge amount of information during the hour-long presentation, but the fact that most stood out to me was that, according to Barnes, between 35 and 50 percent of EMRs will eventually be replaced after just one year of use. (Don’t quote him on the “year,” but I’m pretty sure that’s what he said.) His point being, of course, that providers need to think long and hard about what type of solution they need to fit their workflows before they spend time and money implementing an EMR.

This sentiment was echoed by Kimberly Harding of BCBS Florida in a panel at the iHT2 Summit in Atlanta. As part of a greater discussion on Meaningful Use, she made the comment that just because a healthcare IT product is certified doesn’t mean it’s the best fit for a particular facility.

My takeaway from both of these statements is that providers looking to adopt new healthcare IT tools like EMRs need to take a long, hard look at what their current needs are and what their future needs might be before they even think about demoing products.

They also need to adopt technologies that fit their workflows, not necessarily technologies that have a ton of bells and whistles. Added features won’t do anyone any good if they’re never used properly, never used at all, or used to the detriment of a physician’s productivity.

I kept this sentiment in mind when I read the results of a recent study of 250 hospitals and healthcare systems by consulting firm KPMG. The survey found that “71% of respondents’ organizations are more than 50% finished with their EHR adoptions. Will this 71% be satisfied with their EMRs once fully installed and adopted? How many will realize their product of choice wasn’t the right call? If we apply the Greenway statistic, that could be as many as 125 facilities!

So where is the disconnect? Why are providers making poor choices with presumably the best of intentions? Why has the term “rip and replace” become so well known in healthcare? Are physicians misinformed, or not educated enough? Are they feeling so rushed by Meaningful Use deadlines that they don’t perform proper due diligence? Are vendors part of the problem? If so, shouldn’t they be part of the solution? What role do regional extension centers have to play in all this?

If you have answers, please let me know in the comments below.

Many of you will likely remember my series of posts on EHR down time: Cost of EHR Down Time, Reasons Yor EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. Needless to say, it’s pretty much inevitable that sooner or later you’re going to encounter EHR down time. The key to EHR down time is to think ahead about how you’re going to deal with your EHR being inaccessible.

I started thinking about this a bit more when I came across this FAQ item on Practice Fusion’s EMR user forums.

When there’s a planned maintenance ahead:
•Print your daily calendar for the next day’s schedule
•Know your offline alternatives for handling labs and prescriptions
•Have a plan to document your patient visits so you can input them in the EMR later
•Clear out your To do list and complete any pending Rx refill requests the day before
•Update your web browser and Adobe Flash to the current version

Preparing your office:
•Have a prepaid wireless 3G hub or other back-up internet system ready to go in the event your main internet is down
•Use laptops with good batteries and connect computers to surge protectors and battery back-ups for short term power interruptions
•Identify a second location that you could use temporarily in the case of a serious, long-term outage such as a fire or flood

I’ll always remember the reaction of the director of the health center where I first implemented an EMR to the discussion about “What do we do if the EMR is down?” She basically said, “We can still take care of the patient. We just might have to ask a few more questions.”

Now I’m sure there are cases where a physician might choose not to treat a patient without access to their EHR. There are certainly also cases where you can treat a patient better, faster and with more information with an EHR, but those can either be rescheduled if that’s the case. It’s certainly bad customer service and you should employ techniques to minimize EHR downtime as much as possible. My point is that it’s usually not life or death when the EHR is down. Think about how many patients are treated in an ER every day with no access to the patient’s medical record.

With that said, it is a disruption to the clinic and will be a BIG disruption to your clinic if you don’t have a solid plan of attack for when (not if) your EMR is inaccessible.

I’d focus your efforts in two areas:
•Minimize EMR Down Time
•Plan of Action for When Your EMR Goes Down

Most people do a pretty decent job with the first part. The second part people don’t often give much thought. You can start with some of the comments from Practice Fusion above to build out your plan. I also think it’s worth making a plan for short down time versus long down time. It’s quite different to deal with 5 minutes of down time than 5 days. You should consider both options.

One of the many things that seems to be getting lost in the mix of all the noise about EHR software and the EHR incentive money is medical billing software. As I think through all of the presentations from EHR vendors and discussions I’ve had with doctors, consultants and other professionals in the Healthcare IT industry, I think the practice management system is getting lost in the EHR shuffle. Let me ask some important questions:

Does anyone care about the billing software now? What if the billing software that comes packaged with your EHR sucks?

A regular reader of my sites John Brewer often talks about how many of the benefits we like to talk about with technology in a practice are coming from the practice management system, not the EHR. These days most people seem to consider the EHR and PM one package. Yet, I’ve seen people spend little time really understanding whether the billing side of the EHR is going to work for their practice.

In contrast to this comment though is that I haven’t seen an uproar of people complaining about implementing an EHR and their billing going down the tubes. Does this mean that medical billing software has basically become a commodity that every EHR vendor has done to a reasonably sufficient level that no one has a problem? Or maybe we don’t hear about it much because most doctors aren’t business people.

While I don’t have anything but anecdotal evidence of the disregard to medical billing software, I think this is going to eventually come back to bite us. Although, in our generally provider driven world the EHR matters more in the daily workflow and so this isn’t a surprise that we see the EHR bias during medical software selection. Once the physician sees the reimbursement levels lower, they’ll likely wake up to the reality that you need both a solid EHR and a solid PM.

Anybody catch the recent Mashable.com or CNN articles on the feedback Facebook COO Sheryl Sandberg has received because she makes it a point to leave work at 5:30 pm every day? (You can read them here and here.) In a nutshell, Sandberg has always left the office around that time – a practice she started when she first had kids, but has only felt comfortable talking about it now that she is in upper management and (presumably) somewhat immune to corporate push back. ( Don’t confuse leaving work with not working, by the way. Sandberg, like many others, checks email at all hours.)

Mashable CEO Pete Cashmore, who authored the CNN.com story, summarizes the mini-controversy that has evolved in the tech world as a result of Sandberg’s coming clean: “In a competitive industry where your work is never truly complete, has it become socially awkward to leave work at a time that used to be the standard? And are those working eight-hour days that end at 5 p.m. being quietly judged by their co-workers? Whatever happened to “work-life balance”?

Good questions, to be sure. So good, in fact, that I felt compelled to pose a similar query to a panel of current and former healthcare CIOs – all guys, by the way – at the recent Women in Technology International (WITI) / GAHIMSS event, “Women in Healthcare IT Talk.”

Piedmont Healthcare CIO Mark Pasquale was refreshingly candid in his response: “I don’t have a work-life balance.” His point being that, as a CIO overseeing a near-future EPIC ERP system go-live, his work day never really ends, especially given how connected he is via multiple mobile devices. He also pointed out that, as 85% of Piedmont’s install team is internal, Piedmont spent copious amounts of time preparing that staff for the time commitment required to travel to Epic headquarters in Madison, Wisc., for training. Pasquale kept an open door, and said many staff members came by multiple times to hash out whether committing to such an intense project was the right move for them.

From left to right: Christopher Kunney, The BAE Company; Sonny Munter, Georgia Dept. of Community Health; Mark Pasquale, Piedmont Healthcare; Praveen Chopra, Children's Healthcare of Atlanta

Fellow panelist Christopher Kunney, HIT Strategist at the BAE Company and former CIO of Piedmont, made the point that you have to be aware of what you’re signing up for when you enter healthcare’s executive ranks. Long days aren’t unusual; they are the norm. Children’s Healthcare of Atlanta CIO Praveen Chopra concurred, adding that his wife makes him limit use of his Blackberry on vacation to just one hour a day. Sonny Munter, CIO of Georgia’s Dept. of Community Health, joked that he leaves his job everyday at 4pm – but gets going around 6 in the morning. Munter added that he makes it a point to surround himself with good staff members, which also helps in balancing his work and family obligations.

From left to right: Lisa McVey, McKesson; Gretchen Tegethoff, Athens Regional Medical Center; Patty Lavely, CIO Consulting LLC; Deborah Cancilla, Grady Health System

A second panel of healthcare executives – all female – pretty much agreed with their male counterparts. Patty Lavely, founder of CIO Consulting LLC and former CIO of three different health systems, did echo Facebook’s Sandberg just a bit in her comment on the subject: “There comes a time when you have to say, ‘This [work] will be here for me tomorrow. I need to go home and have dinner with my family tonight.”

All of the panelists mentioned the need to prioritize workplace projects and challenges in a way that is suitable to the particular balance they need in their lives. They have triaged, so to speak, their commitments, priorities, deadlines, etc. to fit their schedules.

So, can healthcare IT folks – providers or vendors, executives or otherwise – ever be off the clock, never mind leave the office between 5 and 6? Share your stories and advice in the comments below.

I’m a regular reader of a number of venture capital bloggers. I love entrepreneurship and consider investing a hobby that I love learning about. One of the best VC bloggers out there is named Mark Suster. I recently saw one of his posts titled, “The Danger of Crocodile Sales.” While Mark takes his post in a few different directions I think we have our fair share of Crocodile Salespeople in the EHR world.

Before I get into some thoughts, here’s how Mark describes a crocodile salesperson: “My favorite was when a guy told me to beware of Crocodile Salesmen. What’s that? ”You know, big mouth and no ears.””

I know I’ve been in some EHR sales presentations that were off the charts good at selling and demoing an EHR product. Based just on that sales presentation I could see how a physician would be very interested in buying that product. Everything went like clock works. They hit so many of the buzz points for doctors that make for a really compelling sell.

The problem comes that with half of the things that are said, in the back of my mind I’m thinking…and now let’s hear the rest of the story. Or the related…what about this, this and that nuance?

Don’t get me wrong. I think there are a lot of really good EHR salespeople who have the best interest of the physician at heart. Plus, there are a number of EHR companies that support this type of sales process. The challenge as I see it is helping the doctors to ask the right questions so they get the right information.

A crocodile salesperson, as described above, makes it a challenge for a physician and their practice to get the information they really need. In some cases you can see why an EHR salesperson exhibits the crocodile characteristics. Some of them just don’t have the in depth knowledge of their product to be able to veer off their sales demo script. They’ve nailed the sales demo, but fall apart when you veer into uncharted territory.

This is exactly why a doctor should make sure to take the EHR salesperson off script. You don’t have to be a jerk about it in the process. You just need to make sure that the sales presentation covers the points that you need covered. Do it in a polite and appropriate way and great EHR salespeople will be happy to go the direction you want to take the presentation. I know doctors time is limited, but it’s worth taking the extra time to get the right information. Ask any physician who’s switched EHR software if they’d wish they’d spent a little more time understanding their first EHR selection. I argue that it is the most important part of an EHR implementation.

My best suggestion to a doctor is to always consider how the EHR software being demonstrated will work in their office. Don’t get so caught up in the bells and whistles of what the product could eventually do in your office that you forget about how you’re going to do your regular tasks. Another common error is for physicians to be so rigid in their requests that they’re not open to any deviation from the processes they’ve used for the past years. No EHR will fit every physician workflow in every way. Consider whether you can see reasonable alternatives to your current processes.

If you want some other suggestions on asking good questions during your EHR sales demo, check out my e-Book on EHR selection. There’s a whole section of it devoted to the topic.

Selecting the right EHR is a hard thing to do. Getting the right information about an EHR and how it will work in your practice is critical. So, be sure to ask the right questions and don’t let crocodile salespeople waste your time and theirs. Make sure that they understand the specific needs of your practice before they start showing you how their EHR software solves those needs. You’ll both be better for it in the end.