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News Flash: Physicians Still Very Dissatisfied With EMRs

Posted on October 18, 2016 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.

Anyone who reads this blog knows that many physicians still aren’t convinced that the big industry-wide EMR rollout was a good idea. But nonetheless, I was still surprised to learn — as you might be as well — that in the aggregate, physicians thoroughly dislike pretty much all of the ambulatory EMRs commonly used in medical practices today.

This conclusion, along with several other interesting factoids, comes from a new report from healthcare research firm peer60. The report is based on a survey from the firm conducted in August of this year, reaching out to 1,053 doctors in various specialties.

Generally speaking, the peer60 study found that EMR market for acute care facilities is consolidating quickly, and that Epic continues to add market share in the ambulatory EMR market (Although, it’s possible that’s also survey bias).  In fact, 50% of respondents reported using an Epic system, followed by 21% Cerner, 9% Allscripts and 4% the military EMR VistA.  Not surprisingly, respondents reporting Epic use accounted for 55% of hospitals with 751+ beds, but less predictably, a full 59% of hospitals of up to 300 beds were Epic shops as well. (For an alternate look at acute care EMR market share, check out the stats on systems with the highest number of certified users.)

When it came to which EMR the physician used in their own practice, however, the market looks a lot tighter. While 18% of respondents said they used Epic, 7% reported using Allscripts, 6% eClinicalWorks, 5% Cerner, 4% athenahealth, e-MDs and NextGen, 3% Greenway and Practice Fusion and 2% GE Healthcare. Clearly, have remained open to a far greater set of choices than hospitals. And that competition is likely to remain robust, as few practices seem to be willing to change to competitor systems — in fact, only 9% said they were interested in switching at present.

To me, where the report got particularly interesting was when peer60 offered data on the “net promoter scores” for some of the top vendors. The net promoter score method it uses is simple: it subtracts the percent of physicians who wouldn’t recommend an EMR from the percent who would recommend that EMR to get a number from 100 to -100. And obviously, if lots of physicians reported that they wouldn’t recommend a product the NPS fell into the negative.

While the report declines to name which NPS is associated with which vendor, it’s clear that virtually none have anything to write home about here. All but one of the NPS ratings were below zero, and one was rated at a nasty -73. The best NPS among the ambulatory care vendors was a 5, which as I read it suggests that either physicians feel they can tolerate it or simply believe the rest of the crop of competitors are even worse.

Clearly, something is out of order across the entire ambulatory EMR industry if a study like this — which drew on a fairly large number of respondents cutting across most hospital sizes and specialties — suggests that doctors are so unhappy with what they have. According to the report, the biggest physician frustrations are poor EMR usability and a lack of desired functionality, so what are we waiting for? Let’s get this right! The EMR revolution will never bear fruit if so many doctors are so frustrated with the tools they have.

KLAS: Strong Support Distinguishes Top EMR Vendors

Posted on June 12, 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.

Wth EMR usability still shaky at best, it’s the developers that offer hands-on support that score highest when EMR usability gets rated, according to HIT researcher KLAS Enteprises, reports Modern Healthcare.

KLAS, which just completed its report “Ambulatory EMR Usability 2013, More Nurture than Nature,” spoke with 163 providers, specifically leaders of practices with more than 25 physicians.  In nearly every case, the magazine said, providers’ greatest frustration was related to vendor relationships, not the software itself, KLAS told MH.

As part of its research, KLAS ranked nine vendors on how well “the typical physician” could efficiently and effectively perform six common EMR tasks/functions, including e-prescribing, medication reconciliation, physician documentation, problem lists, viewing patient information  and supporting mobile devices.

Coming out on top was athenahealth, a Web-based vendor, which topped the list for getting providers to usability at first use, and second for having strong handholding relationships with customers.

Epic, which came up second in the overall composite ranking, was number one when respondents asked whether their vendor gave them good support in guiding them to usability.  This was true despite the fact that Epic is also well known for usability complaints by physicians, and that Epic is built on configurable modules that lead to a steep learning curve.

GE Healthcare and Greenway Medical Technologies tied for third in the composite scoring.

Meanwhile, Allscripts’ Enterprise EHR and McKesson Corp.’s Practice Partner got low scores for initial usability, the magazine said. Allscripts got higher grades for getting customers situated over time; 74 percent ranked the vendor good or okay as compared with 54 percent of McKesson customers.

McKesson had the most customers of any vendor in the survey reporting that the company was “not good” at helping users with its technology.

So, we have an interesting conclusion here: even if vendors turn out a difficult-to-use product, strong customer support can largely erase that disadvantage. Now, let’s see what happens when a big vendor turns out a product which is easy to use without a lot of handholding…

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.

Increasing Revenue Through Clinical Connectivity

Posted on August 27, 2012 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.

As most of you know, I’ve been working hard to create more content related to revenue in healthcare. My interest in this has grown even more since I had the chance to attend the ANI 2012 conference in Las Vegas where I got the chance to talk to people like Rishi Saurabh from GE Healthcare. It’s amazing how many people (myself included) don’t think that revenue cycle management is sexy since there are so many opportunities in healthcare.

One example of missed healthcare revenue management opportunities has to do with connecting clinical content with the financial data. From my experience, it’s quite rare to see a healthcare institution that does a great job of connecting these two pieces of data. The clinical data is in a silo of its own and it’s only looked at by the clinical people. The financial data is in its own financial data silo and only ever looked at by the financial people.

These silos are a problem and present a really big opportunity for healthcare organizations to increase the revenue of their organization. Although, doing so in an organization is not always easy. It takes great leadership to bridge the two content silos. Plus, you need someone who’s effective at understanding both the clinical and financial point of view. So, it’s not hard to understand why this doesn’t happen more often.

I think the most basic example of what I’m talking about can be seen in the annual checkup. I was talking with a colleague the other day when I told him that I couldn’t remember the last time that I’d been to my doctor. In fact, I honestly don’t even know my doctor’s name (which might beg the question of whether he’s really MY doctor). Why hasn’t my doctor sent me a reminder about the need to do an annual physical exam? Why don’t I have a regular connection with my doctor that helps me to take better care of my health?

I think at least part of the answer to this is that the clinical is not tied to the financial. If the clinical were tied to the financial, then the doctor could provide a care plan for me and my specific health needs. Then, the financial could ensure that I’m following that care plan. Imagine the revenue implications of me visiting the doctor regularly as part of a well defined care plan.

I’m sure that many of you out there are likely skeptical about whether patient reminders will actually change behavior. Certainly in many cases, these reminders will be discarded or ignored. However, a certain percentage of those reminders will be followed. This will mean your patients get better care and your clinic increases their revenue. Plus, maybe we need to take a deeper look at the care plans that we offer patients. If large percentages are ignoring the suggestions, then maybe we need to rethink the plan or how we’re communicating that plan to the patient.

There are certainly plenty of other medical examples where a follow up doctor visit would make sense and improve the health of your patients. In fact, you could get really sophisticated with how you reach out to your patient population.

I believe the key to success of this type of program is to integrate the clinical data with the financial data. It creates tremendous power and amazing opportunities.

Global eHealth Olympics

Posted on August 9, 2012 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.

Blair Butterfield is a senior health IT executive and eHealth expert with over twenty years of global experience in new market and business development, general management, government initiatives, strategic marketing, product strategy and consulting. He is currently president of VitalHealth Software’s North American Division and is the former VP of eHealth International Development for GE Healthcare.

For nearly two weeks, all eyes have been on London as we’ve watched athletes vie for gold in the world’s foremost sports competition. It makes you wonder what would happen if that same competitive nature was applied across other aspects of our national identities—namely healthcare. What if we compared our healthcare system to those of Europe, Asia and the Middle East in terms of areas like integration, communication and population health? How would the U.S. fare?

With the global healthcare system in the midst of a major transition, now is the perfect time to look at how the U.S. compares to other nations, especially with respect to one of the biggest trends we’re seeing worldwide—eHealth. eHealth can be described as the use of information technology to facilitate higher quality, more accessible healthcare at lower costs. As countries across the globe amp up their eHealth programs, they are seeing that the success of these major transformations requires engagement and support by all stakeholders, as well as strategic, controlled governance of eHealth implementation.

While the healthcare industry is experiencing a shift on a global level, the strategies and methods for eHealth initiatives vary at the national level. If we were to look at how different countries compare in the healthcare arena, eHealth Olympic events would include:

  • Standards adoption
  • Terminology and coding adoption
  • Patient consent policies
  • Interoperability infrastructure
  • Prevalence of EHRs
  • National funding for eHealth
  • National governance for eHealth
  • Tolerance  for regional variations
  • Import/export of eHealth best practices

In terms of these events, let’s take a closer look at some of the top medal contenders across the world to see why they have had eHealth success in particular areas:

Standards, Terminology and Coding Adoption

For these events, France and Austria are definite medal contenders. France has employed an incremental eHealth strategy that includes a standards-based architecture at the core, which has allowed vendors to test and adopt standards that address IT and clinical needs in a coherent, proven framework. Austria’s eHealth strategy includes a data sharing architecture that enables data portability and standardization of clinical content. By employing an IHE-XDS sharing architecture, Austria’s system has allowed for seamless data content sharing without disrupting the sharing infrastructure. Also Austria had a very clever “training regimen” that resulted in full adoption of coded data elements by physicians who had initially pushed back against it until they realized the value of coded data.

Interoperability Infrastructure

As England was one of the first countries to invest heavily in eHealth, its early adopter status has allowed the country to improve upon its infrastructure, namely in terms of interoperability. England’s eHealth strategy uses an interoperability “spine” to connect regions of the country. This sharing of health records of documents on the spine has ultimately proved effective by reducing costs and complexity while simplifying data sharing models. It took more than one try to medal, as the first attempt was a failure and resulted in a “back to the drawing board” decision to re-design the infrastructure using newer standards and profiles based on IHE.

National Governance and Funding with Regional Variations

To take the overall gold in eHealth, a key component is a balance of national strategy enforcement and tolerance for regional variations, which is prevalent in the strategies of both Canada and the U.S.  Canada’s federally funded “Canada Health Infoway” has established a national EHR blueprint, while EHR implementation itself is governed at the sub-province level and driven by local priorities, such as funding and regional business drivers. Similarly, the larger health reform legislation in the U.S. wraps around the IT program with a national eHealth funding budget of $30 billion for a wide range of related programs. At the same time, the U.S. recognizes regional variations in IT drivers and business needs as the value propositions to support long-term maintenance of HIEs. In  addition, the national funding of regional extension centers assists providers in complex processes of selecting and implementing healthcare IT systems that are right-sized for their organizations with an adequate training and support infrastructure to ensure successful adoption, modeled on the same lines as the regional agricultural assistance program from decades ago that taught farmers about best practices.

Import/Export of eHealth Best Practices

As previously stated, England’s head start in eHealth investment and adoption has given the country a wealth of learning and best practices that can be shared with other nations looking to employ strategies of their own. Countries like Singapore have been very receptive to this information sharing as its strategy includes global sourcing for expertise and investing in technology to enable interoperability. However, the top-honor for eHealth collaboration may go to Canada as the nation has shown ample willingness to be collaborative with other countries and adopt best practices from around the world. It should also be noted that willingness to learn from other countries’ eHealth strategies is an area where the U.S. has typically fallen short.

In addition to evaluating these eHealth best practices around the globe, it’s important to note fundamental strategies that should be employed in all nations, including: the need to address privacy and security concerns at the onset of the program; ensuring clinician involvement during the entire process; providing ongoing education and training; and employing an incremental adoption strategy.

Though we are seeing eHealth success at varying levels around the world, what is being built today is just the foundation for the future of IT-enabled healthcare delivery systems—no nation has yet realized the vision of patient-centric prevention and disease-management, evidence-based medicine, and ubiquitous provider use of IT. So although countries across the globe are closely competing for eHealth’s top honor, no one country can claim that elusive, exclusive gold. With a vision of connected healthcare, where health information exchange powers population health management, patient activation, clinical decision support, community analytics, collaboration, and information liquidity, competition to win the gold medal in eHealth initiatives should be a huge motivating factor towards improved performance.

Revenue Cycle Management Interview with Rishi Saurabh – GE Healthcare

Posted on July 25, 2012 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.

As most of you know, I had the chance to attend the ANI 2012 conference in Las Vegas that’s put on by HFMA. This conference is a hospital CFO’s home since all of the major players in the healthcare financial management space were in attendance. Around every corner was another Hospital CFO it seemed.

While at the conference, I was able to corner the Global Product Marketing Manager at GE Healthcare, Rishi Saurabh, for a short video interview about revenue cycle management. In the video Rishi provides his insights into the biggest challenges facing hospitals today and also provides some insight into how GE plans to approach these challenges. I hope you enjoy the video:

Meaningful Use Attestation: GE Admits Problems with Two Centricity Products

Posted on October 24, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

If you have been using GE Healthcare’s Centricity Practice Solution or Centricity Electronic Medical Record solution to demonstrate Meaningful Use, you might be in for something of a rude shock. According to an InformationWeek Healthcare story by Neil Versel,

“Some customers of GE Healthcare may not be able to achieve Meaningful Use with their current electronic health records (EMR) systems, as the vendor has discovered “inaccuracies” in its software’s reporting functions.”

According to Versel, GE admitted the problem in a letter that went out to users of the two Centricity products on Thursday and promised a solution by end-November. At the time the InformationWeek story was written, this GE link was not working, but is now. In the document, GE details exactly where its reporting was going wrong. It appears as if the problems lay in the following areas:
– the default race and ethnicity provided by GE’s Centricity products didn’t always map exactly to OMB’s race and ethnicity categories (as an example, GE’s Centricity provided for a single Multi-Racial category, whereas OMB requires that a multiracial person be allowed to select as many races as s/he wants)
– inaccurate recording of smoking status
– inadequate training of doctors on educating their patients about medications
[Link]

Among the recommendations put forward by GE:

– If you’ve already attested for 2011, run reports again for attestation period once GE issues its software update. If the results don’t match up,
a) check if you clear all applicable Meaningful Use thresholds for the original period
b) check if you meet thresholds for all applicable measures

– If you haven’t attested for 2011, hold off on attesting till GE issues its updates.

– Prospectively follow GE’s recommendations for the rest of the year

While the GE letter points out there is still time till Feb 29, 2012 for 2011 attestations, these were my first reactions to reading this piece of news:
– Even a Stage 1 Meaningful Use certified software from a well-known company is not immune to inaccuracies in reporting

– It might seem like a trivial change to move from “Multi-racial” to allowing multiple check-boxes for races, but it could mean the difference between demonstrating MU and not being able to. From GE’s perspective, I would want to know why these small-seeming errors were not caught at the time these Centricity products were Stage 1 MU certified

– How many/what percentage of Centricity EMR and Practice Solution users were affected? It’s not very clear/GE doesn’t say.

– The letter and recommendations don’t show up on GE Healthcare website, and to me it’s also quite interesting that a story like this doesn’t have any hits beyond the InformationWeek article.

– Are there any recourses apart from following GE directives? Maybe if you have softwares other than GE’s Centricity, maybe you can cross-check your results. But I don’t know how many practices actually can afford two or more EMRs. So this really might be a worthless suggestion, unless you can press one of those free EMRs into service!

Full Disclosure: GE is an advertiser on this site, but I’m not sure Priya Ramachandran knew that when she wrote this article.

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.

 

 

 

GE Promotes EMR Through Patient Safety Organization

Posted on February 21, 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, here’s a vendor move which I’m surprised others haven’t made yet (at least to my knowledge).

GE Healthcare has formed an official Patient Safety Organization, one blessed by HHS and AHRQ, a step which puts its EMR in the hospital buyer’s face without its having to constantly pitch.

As I see it, this is a clever move which not only helps GE gather data useful in refining Centricity, but also helps make sure people don’t think of safety problems when they think EMR.

The PSO works as follows.  GE has brought together sixteen hospitals, most in Rhode Island, to share data on medical errors.  The data will be captured through MERS, a Web-based event reporting system which all participants will use.   To handle heavy-duty data crunching, GE’s PSO is working with SAS, whose job it will be to integrate and analyze root causes that  contribute to risk.

Not only does this promote GE Healthcare’s brand, it also tightens the bond between itself and the hospitals, which may become reliant on the integration and data management capabilities vendor like SAS can supply.  (Somehow, I doubt your average community hospital has SAS  on board;  its products are just too costly.)

All told, a very interesting development.

EMR by the Numbers Video

Posted on September 3, 2010 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 find it interesting that I was sent another EMR YouTube video. No doubt YouTube can be a great tool for getting the word out, but so far the views on EMR videos are pretty low. However, I must admit that this video by GE Healthcare is much more interesting than the previous meaningful use video I posted. Plus, they focus on physicians number 1 concern: productivity and reimbursement. Take a look for yourself.