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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.

Meaningful EHR Use, Meaningful Use Stage 2, and Robotic Glove – Around HealthCare Scene

Posted on September 2, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and HIPAA

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now

This is a great summary of meaningful use stage 2. It’s a real practical look at what you should expect from meaningful use stage 2.

A Smart Approach to Medicine and Social Media

Dealing with patients via the Internet and social media may seem daunting. When should it be done, and what limits should be maintained? Katherine Rourke takes ideas from an article about handling social media communication with patients, written by Dr. Vartabedian, and contributes her thoughts as well.

10 Ways to Meaningful EHR Use for Doctors

With the frustration that sometimes comes with implementing an EHR, some doctors may just want to give up. However, beyond that initial frustration, it can be very helpful is the creators keep a few things in mind. This post contains a list of 10 ways developers can do this, created by Rob Lamberts, MD. It includes ideas like allowing e-prescription for all controlled drugs, and requiring all visits to have a simple summary.

ACOs

A number of really interesting ACO stats. Plus, there’s a great look at who will be driving the ACO. Will it be the payers, physicians or hospitals? This is a challenging question and the battle between the various stakeholders is on.

Hospital EMR and EHR

Hospitals Adjusting to Meaningful Use Stage 2 Rules

With all the complaints that came with MU Stage 1, there was bound to be many with the release of MU Stage 2 rules. Unfortunately, it is something that cannot really be avoided, just adjusted to. The HIE requirements do, surprisingly, seem to be light. Anne Zieger talks about how hospitals are adjusting, and some thoughts on the recently released rules.

Smart Phone Health Care

Robotic Glove That Diagnoses Illnesses: Coming To A Doctor’s Office Near You – #HITsm Chat Discovery

A new invention may create less visits to the doctor’s office. Created by two engineers and a med student at Harvard, the robotic glove supposedly can detect many different illnesses, such as breast cancer or enlarged lymph nodes. It has not been released yet, but it hopefully will eventually reach it’s way to consumers.

Laser Developed to Detect a Person’s Vegetable Intake – #HITsm Chat Discovery

It won’t be hard for doctors to detect a person’s diet soon. A laser has been developed which measures the level of carotenoids present in a person body. The fiber optic probe is placed on a person’s hand, and within seconds, and accurate reading is available. There are many possibilities that arise with this invention – to aiding in studies, to determining whether a person’s diet is contributing to their health problems.

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!

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.

Modular Software Unleashes Innovation – Major EHR Developments Per Halamka

Posted on September 23, 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.

In my ongoing series of Major EHR Developments from John Halamka (see my previous EHR In The Cloud post), his second major EHR development from the Technology Review article is: Modular Software Unleashes Innovation. The following excerpt from his article sums it up well:

Until very recently, innovation in medical IT has depended upon the development schedules of a few very large vendors who sell hospital systems with $100 million price tags. In the future, electronic health records will become increasingly modular, similar to the online app stores where consumers download games or programs for their phones.

The idea of modular healthcare IT has been around for a long time. I think I first saw this concept when I learned about a group called the Clinical Groupware Collaborative. I haven’t heard much out of them recently, but every once in a while I see that they’re still working to make Halamka’s comments about modular EHR software a reality.

I’m certain that Judy from Epic would argue that such modular EHR software is a risk to the healthcare industry. She’s probably right. There are risks to modular software. However, there are even more risks and disadvantages associated with a monolithic EHR vendor that won’t interact with other modular clinical software. I believe that one day this will come back to bite Epic as new CIO’s who weren’t part of the $100 million hospital software purchase will start to embrace a more modular strategy.

Turns out that I think providers will actually be the strongest proponents of the modular strategy. They’re already buying mobile devices with money out of their own pockets and so they’re going to start using apps that will help them provide better care. Hospitals will have a hard time controlling it and they’ll eventually realize that the best way to control it is to embrace it.

The most unfortunate part of this EHR development is that it’s going to take a long time for this development to become a reality. However, little by little we’ll get there.

EHR In the Cloud – Major EHR Developments per Halamka

Posted on September 14, 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.

As most of you know, John Halamka is publishing content everywhere. In fact, maybe I should see if he’ll publish some here. Halamka is really smart and respected by many for good reason. So, I was intrigued to find an article in the Technology Review (an MIT publication) where Halamka higlights what he considers the major EHR and healthcare IT developments over the next five years.

I’ve been doing a number of series lately on EMR and EHR & EMR and HIPAA and since people seem to really like them, I decided I’d make Halamka’s major EHR developments into a series as well.

The first Major EHR Development is: EHR In the Cloud

In the article above, Halamka offers some interesting comments about doctors being doctors and not tech people, the issues of privacy in the cloud and hospitals leaning towards “private clouds.” Let’s take a look at each of these.

Doctors Don’t Want to be Tech People
While there are certainly exceptions to the rule, it’s true that most doctors just want their tech to work. They don’t want to spend a weekend installing a server. There’s little argument that a SaaS EHR requires less in office tech. This fact will end up being a major driving force behind the adoption of SaaS EHR software over the client server counterparts.

Certainly, many doctors will still feel comfortable with their local IT help doing the work for a client server install. Also, many still feel more comfortable having their EHR data stored on a server in their office. This issue will continue to fester for a long time to come. At least until the SaaS EHR vendors provide doctors a copy of their data which they can store in their office. Plus, SaaS EHR are much faster today than they were, but there’s still a few things that a client server can do that is just flat out faster than client server.

I still see the ease of implementation and “less tech” helping SaaS EHR software to continue to gain market share.

Privacy in the Cloud
The biggest problem here is likely that doctors aren’t technical enough to really understand the risks of data in the cloud or not. Plus, I think you can reasonably make an argument that both sides have privacy risks. Most people are becoming much more comfortable with data stored in the cloud. I expect this trend to continue.

Private Clouds for Hospitals
Halamka claims that he, “estimates that moving infrastructure and applications to my hospital’s private cloud has reduced the cost of implementing electronic health records by half.” Of course, we have a lot of possible definitions of “cloud” and I’m not exactly sure how Halamka defines his private cloud. However, anyone who’s managed client installs of EHR software, including client upgrades, etc knows some of the pains associated with it. I’d be interested to know what other savings Halamka and Beth Israel Deaconess Medical Center get from their “private cloud.”

Cloud and EHR
There’s one thing I can’t ever get out of me head when I think about EHR and the cloud. Someone once told me (sorry I can’t remember who), “The cloud has always won in every industry. It will win in EHR too.” I hate when people use terms like always and every, but I haven’t (yet?) found an example to prove that person wrong.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 56-60

Posted on August 22, 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.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

60. Reporting, reporting, reporting, reports
What’s the point in collecting the data if you can’t report on it? I’ve before about the types of EMR reports that you can get out of the EMR system. The reports a hospital require will be much more robust than an ambulatory practice. In fact, outside of the basic reports (A/R, Appointments, etc), most ambulatory practices that I know don’t run very many reports. I’d say it’s haphazard report running at best.

Although, I won’t be surprised if the need to report data from your EHR increases over the next couple years. Between the meaningful use reporting requirements and the movement towards ACO’s, you can be sure that being able to have a robust reporting system built into your EHR will become a necessity.

59. Are the meaningful use (MU) guidelines covered by your product?
Assuming you want to show meaningful use, make sure your EHR vendor is certified by an ONC-ATCB. Next, talk to some of their existing users that have attested to meaningful use stage 1. Third, ask them about their approach for handling meaningful use stage 2 and 3. Fourth, evaluate how they’ve implemented some of the meaningful use requirements so you get an idea of how much extra work you’ll have to do beyond your regular documenting to meet meaningful use.

58. It they aren’t CCHIT certified take a really really hard look
Well, it looks like this tip was written pre-ONC-ATCB certifying bodies. Of course, readers of this site and its sister site, EMR and HIPAA, will be aware that CCHIT Has Become Irrelevant. Now it’s worth taking a hard look if the EHR isn’t an ONC-ATCB certified EHR. There are a few cases where it might be ok, but they better have a great reason not to be certified. Not because the EHR certification provides you any more value other than the EHR vendor will likely need that EHR certification to stay relevant in the current EHR market.

57. What billing systems do you interface with?
These days it seems in vogue to have an integrated EMR and PMS (billing system). Either way, it’s really important to evaluate how your EMR is going to integrate with your billing. Plus, there can be tremendous benefits to the tight integration if done right.

56. How much do changes and customizations cost?
In many cases, you can see and plan for the customization that you’ll need as part of the EHR implementation. However, there are also going to be plenty of unexpected customizations that you don’t know about until you’re actually using your EHR (Check out this recent post on Unexpected EHR Expenses). Be sure to have the pricing for such customizations specified in the contract. Plus, as much as possible try to understand how open they are to doing customizations for their customers.

Check out my analysis of all 101 EMR and EHR tips.