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Hospital CIOs Cutting Back on Non-Essential Projects

Posted on July 10, 2014 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.

Generally speaking, cutting back on IT projects and spending is a tricky thing. In some cases spending can be postponed, but other times, slicing a budget can have serious consequences.

One area  where cutting budgets can cause major problems is in preparing to roll out EMRs, especially cuts to training, which can lead to problems with rollouts, resentment, medical mistakes, system downtime due to mistakes and more.  Also, skimping on training can lead to a domino effect which results in the exit of CEOs and other senior leaders, which has happened several times (that we know of) over the past couple of years.

That being said, sometimes budgetary constraints force CIOs to make cuts anyway, reports FierceHealthIT Increasingly projects other than EMRs are falling in priority.

A recent survey of hospital technology leaders representing 650 hospitals nationwide published by HIMSS underscores this trend. Respondents told HIMSS said that despite increases in IT budgets, they still struggled to complete IT projects due to financial limitations. In fact, 25 percent said that financial survival was their top priority.

What that comes down to, it seems, is that promising initiatives fall by the roadside if they don’t contribute to EMR success.  For example, providers are stepping back from HIE participation because they feel they can’t afford to be involved, according to a HIMSS Analytics survey published last fall.

Instead, hospitals are taking steps to enhance and build on their EMR investment. For example, as FierceHealthIT notes, Partners HealthCare recently chose to pull together all of its EMR efforts under a single vendor.  In the past, Partners had used a combo of homegrown systems and vendor products, but IT leaders there  felt that this arrangement was too expensive to continue, according to Becker’s Hospital Review.

This laser focus on EMRs may be necessary at present, as the EMR is arguably the most mission-critical software hospitals have in place at the  moment. The question, as I see it, is whether this will cripple hospitals in the future. Eventually, I’d argue, mobile health will become a priority for hospitals and medical practices, as will some form of  HIE participation, just to name the first two technologies that come to mind. In three to five years, if they don’t fund initiatives in these areas, hospitals may look  up and find that they’re hopelessly behind .

Hospital Halves Sepsis Deaths Using EMR

Posted on January 2, 2014 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.

Two years ago, New York City’s Mount Sinai Hospital was struggling to catch cases of sepsis early enough to save lives. Since then, the hospital has almost halved the number of sepsis deaths taking place there thanks to use of its EMR, according to a piece in the Canadian Medical Association Journal.

Attacking sepsis deaths is critical for hospitals worldwide, which have been fighting what has been described as a losing battle against the condition. According to the CMAJ, hospitalizations for sepsis have more than doubled over the last 10 years, and an estimated 1/3 to 1/2 of those patients die as a result of the condition.

Early treatment with antibiotics and intravenous fluids can reduce the risk of death from sepsis by half, but treatment is often delayed because symptoms are not specific enough to raise the alarm.

In 2011, Mount Sinai’s overall mortality rate and sepsis mortality rate were both unusually high compared with other academic medical centers in the U.S., according to Dr. Charles Powell, chief of pulmonary and critical care medicine, who spoke to CMAJ. Sepsis, in fact, accounted for about half of all deaths at the hospital.

Mount Sinai implemented an early warning and response program on eight floors, beginning in 2012, in which the hospital’s EMR triggered a red alert whenever staff entered vital signs in a patient’s chart that matched the criteria for early sepsis.

When the alert was triggered, it prompted a bedside call from a team of specially trained nurse practitioners who evaluated the patient, ordered tests, and if necessary began immediate treatment.

During that first year there were 77 fewer deaths from sepsis, representing a 40 percent reduction in the hospital’s sepsis mortality rate compared to 2011. Since then, things have only gotten better.

“When we began the program, the mean sepsis mortality rate was about 33 percent… Now it’s at 16 percent,” close to the lowest rates among peer hospitals, says Powell. Not only that, the hospital identifies patients with sepsis earlier so it can standardize its response. Then, using EMR data, the hospital can also measure it sepsis response in terms of timeliness and outcomes, including both transfers to intensive care and mortality, Powell notes.

Will Hospital Ownership of Small Practices Kill Ambulatory EHR Vendors?

Posted on August 30, 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.

There are a lot of interesting trends in the EHR and healthcare industry right now. One trend that everyone is seeing and talking about is the trend of hospitals buying up ambulatory practices. There are a number of reasons that we see this happening. Not the least of which is the move to Accountable Care Organizations. While I still think that this trend is cyclical, there’s some possibility that the small ambulatory practice might be in long term danger.

If the small ambulatory practice is in danger, what does that mean for EHR software vendors?

One of the first projects that hospital acquired practices experience is the move to the hospital owned EHR. In fact, I know of many cases where the move to the hospital EHR was part of the contract. I’m not sure all of the reasoning, but many hospital systems are moving their recently acquired practices onto EHR before they move their existing practices.

I have yet to see a hospital system use anything but a large EHR vendor. In many ways it makes sense. The hospital system is buying practices across dozens of specialties. Many of the smaller EHR vendors focus on a few different specialties and so they just aren’t an option for a big multi specialty environment.

Then, there’s the issues of scale and control. Can a smaller EHR vendor support such a large implementation? Can a smaller EHR vendor provide the hospital system the control they want of their EHR environment? The first one is an interesting challenge since I’ve seen some hospital owned ambulatory environments having scaling issues with some of the largest EHR vendors. The problem as I saw it from the outside was that the hospital system couldn’t get the attention of the right people at the large EHR vendor. This wouldn’t have been an issue at a small EHR vendor.

With that said, I do think that small EHR vendors will have a huge challenge getting into the large hospital owned clinical practices. Will enough small practices remain for ambulatory EHR vendors to survive? I enough will survive, but in the short term there could be some shrinking of that market.

Who do Doctors trust in EHR Selection?

Posted on March 29, 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.

Anne Zieger has a really interesting post about Hospital Recommended EHR software over on Hospital EMR and EHR. In it she talks about how most doctors don’t take the hospital recommended EHR software. This will come as little surprise to doctors and likely to hospital systems as well. Doctors and hospitals have always had a mixed bag relationship. There’s this odd co-dependence that usually makes the relationship awkward.

When it comes to EHR adoption, physicians love the idea of getting IT and implementation support from the hospital. They also love the group buying power. Although, they also are concerned that they’ll just be a small fish in the big hospital waters and not get the support that they think they deserve (and maybe they do). Although, the most important reason doctors don’t want to get the hospital recommended EHR is they don’t want to create that “permanent” tie to the hospital. Of course, this is one major reason why hospitals want doctors to take their recommended EHR.

If we can say that doctors don’t trust hospitals recommended EHR software, then who do they trust?

That answer is easy: other doctors.

There’s something really powerful about the trust connection that doctors have between themselves. I’m sure there’s a number of factors that contribute to why they trust doctors more. It probably goes back to the bond that going through medical school creates. Reminds me of when my brother described how boot camp in the Marines created a unique bond between Marines. Doctors seem to experience a similar bond around medical school. Even if they’ve never met before, they can connect sharing “war stories” from their medical school and residency experience.

In many cases, their physician colleagues are a great reference pool for them when it comes to EHR selection. This is particularly true if their colleagues are in the same specialty and have a similar practice size. Although, once doctors start talking to colleagues from different specialties or different size institutions then they often run into trouble. The EHR that works for a 100 office multi-specialty clinic likely won’t be the right one for a solo practice.

IT Service Companies
I also believe many practices have a great trust in their IT service provider. You can see this trend in how many IT service company employees comment and subscribe to this site. Plus, many of them offer some sort of specialized EHR service to doctors. In fact, many are VARs for EHR vendors.

Internet EHR Info
Turns out that most doctors are very independent thinkers. So, many of them want to do the EHR selection on their own. This leads them to the internet to search and narrow down the list of EHR companies. I expect the internet resources for EHR are probably now the most influential part of a physician’s EHR selection process. Can you imagine a physician selecting an EHR without online research? I can’t.

Who else do you see influencing the EHR selection process?

One ED Doctor’s View on EHR: A “Certified Nightmare”

Posted on February 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I’ve written more posts than most about doctors and the EMRs they love to hate. But too often, observers like myself are forced to share stats from research organizations or (potentially suspect) ratings by groups like KLAS that poll doctors. Not only are stats a bit sterile, they gloss over some of the idiosyncratic issues doctors face when they take on an EMR.

This time, I had the pleasure of a heart to heart with an ED physician. I got more out of our brief conversation than I have in months of writing up survey “results” from interested parties.

The physician, a left-coaster who works with a large non-profit chain, spent a bit of his time telling me about his experiences with his EHR, which is installed in hospitals where he works.

His conclusion:  his EHR deserves the “Certified Nightmare” nickname it’s won among the medical staff.  From what he says, the EHR installation he’s dealing is way too hard to use.  To him, the user interface imposes a nasty “click burden” that slows him down needlessly.

Before you leap to the conclusion that he’s a Luddite, know that our friendly ED doc is completely paperless at home and that this EHR isn’t his first EHR.  He’s actually pretty fluent with technical stuff.

So I have to believe him when he says that the EMRs he’s looked at are clumsy as heck. “The height of EMR design seems to be Microsoft Outlook 2003,” he says. I wish he was wrong!

US EMR Market to Exceed $8 Billion in 2016

Posted on January 2, 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.

In case you missed it, I’ve moved a lot of my discussion of the EMR and Health IT markets to my site: EMR Thoughts. I’ve done a lot of posts on that site that look at the EMR market, the health IT investments, the Health IT incubators (or accelerators if you prefer), and other movement in the EMR, EHR and Health IT markets. If you like that type of content, you should definitely subscribe to the EMR Thoughts email list.

Even though, I’ve moved a lot of my EMR market discussion to the other site, every once in a while I’ll drop in some EMR market stuff on here as well. In the article linked in my Costco EMR post, they discussed the size of the EMR market:

Millennium Research Group said in its November report, “U.S. Markets for Electronic Medical Records 2012,” that the U.S. market for EMRs will exceed $8 billion by 2016, with the fastest-growing segment occurring in the small-practice market. Web-based EMRs that don’t require an expensive information technology infrastructure are contributing to the growth, the report said, because they are an affordable option for small practices on tight budgets.

I always hate when they don’t split the EHR market into ambulatory EHR and hospital EHR. I also still haven’t figure out a good way to reconcile that the EMR market in the US will be $8 billion in 2016, but we’ll have spent a good portion of the $36 billion of EHR stimulus money by 2016. Those two numbers don’t jive very well.

I also find it interesting that the fastest-growing segment of the EMR market is the small-practices. I’m not sure I agree with this. I think the larger sales and hospital EHR sales are brisker than the small practice EMR market. Much of the small practice market is still “waiting and seeing.”

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.

Critical Access Hospital EMR & EHR Market Series on Hospital EMR and EHR

Posted on October 11, 2011 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.

For those of you that work in the Hospital EMR and EHR market or have an interest in hospital healthcare IT, you should go over right now and make sure you’re subscribed to our sister site: Hospital EMR and EHR. The content that’s being created on that site is phenomenal.

For example, Chris O’Neal from KATALUS Advisors just finished a series of posts covering the Critical Access Hospital EMR & EHR market. Here are the posts from the series:
How Big is the Health IT Market for Critical Access Hospitals?
Pressures on Critical Access Hospitals – IT Budgets, Competition and IT Talent Retention
What Are the Health IT Trends Working in Favor of Small Hospitals?
Which Health IT and EHR Vendors Should Critical Access Hospitals Consider?

I’ve got another post titled The Argument for Meditech on the way as well. I’ve really enjoyed working with Chris and KATALUS Advisors on these posts and I believe we’ll have even more great Hospital EMR and EHR content from them in the future.

Plus, many of you probably remember many of the great posts here on EMR and EHR by Katherine Rourke. She has such a love for hospitals, that Katherine’s now posting on Hospital EMR & EHR. You can find all of her posts here.

Healthcare IT and EMR Events

Posted on August 7, 2011 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’ve been looking over the next couple months and I realize I have more travel than I usually do. However, there are a number of events I want to attend and so I guess you got to do what you got to do. The good thing is that I love going to healthcare IT and EMR related events. I learn so much and meet a lot of really interesting people.

Here’s what I have on the agenda so far. I’d love to meet readers of the site at these events as well. So, let me know if you’ll be at the event or if you want to catch me before or after the event. (P.S. I posted something similar to this on EMR and HIPAA a while back, but the readership doesn’t crossover that much so I’m posting it here now).

Health Tech Next Generation – San Francisco August 12th – I’m actually doing an EMR panel at this event. Plus, I’m really excited with the meetings I have setup around this event. In fact, my trip to San Francisco is already packed. I’m also excited to see Guy Kawasaki speak in person.

Hospital and Healthcare IT Conference – Phoenix, AZ September 28-30, 2011 – I saw this conference and loved the Reverse Expo concept. Plus, I had an added interest in a conference like this since I am looking to dive deeper into the Hospital EHR world with my new site Hospital EMR and EHR. Katherine’s been writing over there for a bit now and she’s creating some interesting hospital EMR related content.

AHIMA Convention and Exhibit – Salt Lake City October 1-6 – I kept hearing people saying I should go to AHIMA. Well, it’s just up the road from me by where my folks live, and so I figured now was as good a time as ever to check out AHIMA. I don’t know what to expect really, but I’m sure I’ll learn a lot and get some new perspectives.

MGMA Annual Conference – Las Vegas October 23-26 – I can’t wait for MGMA to hit Las Vegas (my hometown). It will be my first time attending, but I’m excited to see all the EMR talk that’s sure to occur. Plus, I bet their exhibitor list will be right up my alley. I’ll be surprised if I make it to many sessions at all. I’ve been thinking of throwing a New Media Meetup at MGMA like I’ve done at HIMSS. What do you think?

There you have it. Any other conferences that I should try and squeeze into my plans? That’s pretty fully, but I could always be convinced for the right opportunity. I’m even talking to some people who organize a healthcare IT conference in Asia. I think a little international EMR and healthcare IT flare would be interesting.

I hope I get to meet a lot of readers at these various events. For those that can’t attend, I’ll do my best to bring you the best insights I can from each event.