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Hospital CIOs Cutting Back on Non-Essential Projects

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 .

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 @annezieger on Twitter.

Digital Health, Connected Health, Wireless Health, Mobile Health, Telehealth – You Choose

Neil Versel posted a great poll asking people which term they prefer. You can vote on it below:

I usually don’t dig into the terminology and branding side of things. At the end of the day, for me it’s all about making sure that we understand each other. If you call something digital health or connected health or mobile health, they’re all the same genre of item. To be honest, I mostly ignore all of those words and want to know what the application actually does.

However, Neil brought up a good point in his post about the lack of consensus in his poll. Here’s his summary of the poll results:

In any case, these results, however unscientific they may be, are representative of the fact that it is so hard to reach consensus on anything in health IT. They also are symbolic of the silos that still exist in newer technologies.

Consensus in healthcare is really hard. I’m reminded of what someone at the Dell Healthcare Think Tank event I participated in said, “Healthcare is second only to florists when it comes to market fragmentation.” It’s like steering a ship with hundreds of rudders all pointing different directions. Certainly not an easy task and not something I see changing soon.

May 7, 2014 I Written By

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

All I Got for Christmas was a New Digital Health App

Last week, I wrote that “All I Want for Christmas is a Doctor’s Appointment.” Turns out what I got – a flu-like cold – put that need into perspective. As luck would have it, I had recently read an article by fellow Healthcarescene.com blogger Neil Versel about AskMD, a new app from the folks at Sharecare. Being a mother of two children who are both in school, and thus exposed to their fair share of colds, I thought I’d get good use out of the symptom checker, which Versel explains, enables users to “choose which symptoms they are feeling and then see which potential health issues they might have. The app then walks the user through a “consultation” in which the app will ask the user a series of questions to identify more specifically what the symptom feels like, when it started, and if there are any other symptoms accompanying it. After the “consultation,” the user can enter in any information about medications that they are taking. When users have finished entering information, AskMD generates a list of potential problems the user might have ordered by the commonality of the potential problems.”

Before rushing to try and make an appointment with my local primary care physician during Christmas break, I decided to give AskMD a whirl. Anything that could potentially save me a co-pay, crowding into a waiting room with other sick folks, and then ultimately being told by my kindly nurse practitioner that the only treatment is rest and fluids, would be beneficial. After entering in an initial main symptom, the app took me through a series of 19 questions, resulting in a list of 11 possible causes, plus a link to find physicians and prepare for my visit. The list of physicians was helpful, and I was surprised to see that Cartersville Medical Center, where I had surgery over the summer, sponsored the results. It’s promising to see small, community hospitals are recognizing the importance of digital health tools.

photo

While a nasty cold wasn’t something I had bargained for over the holiday, it’s nice to know that a digital health app can bring me some peace of mind as I decide whether to treat my symptoms at home, or ultimately go into the doctor’s office. What digital health app did this Christmas bring your way? Or perhaps a new EMR was on your wish list? Let me know what health IT tools you’ll be ringing in the new year with in the comments below.

December 26, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Developing Safety Critical Healthcare Software

The Healthcare IT Guy, Shahid Shah, has a great post up on his blog about writing safety critical software using an agile, risk-based approach. Here’s a portion of the blog post where Shahid really hits the nail on the head:

Much of that [every software being custom] changed in the 90’s and then upended even further in the early part of the 21st century; we should no longer weighed down by the baggage of the past.These days even our hardware is agile and extensible, real-time operating systems are plentiful, software platforms are malleable, mHealth is well established, and programming languages are sophisticated so we need to be open to reconsidering our development approaches, especially risk-based agile.

Why should we use “risk-based” agile? Because not every single line of code in software can or should be treated equally – some parts of our medical device software can kill people, many parts merely annoy people, but most other parts simply aren’t worth the same attention as the safety-critical components. When you treat every line of code the same (as is often true in a plan-driven approach) and you have a finite amount of resources and time you end up with lower quality software and less reliable medical devices. It’s not fair to blame the FDA for our own bad practices.

I’m always amazed by Shahid’s knowledge and ability to describe something in simple terms. I should know since I’m often on calls with Shahid since he’s my partner in Influential Networks and Physia.

The irony is that in the EHR and mHealth world you could argue that many have taken too much of a lean approach to building their applications while the medical device world treats every part of the software as a patient safety issue. Now if we could just bring the two together into a more reasonable balance of what’s important from the safety side and what’s not.

As far as I can tell, the FDA is planning to mostly stay out of regulating the general mHealth and EHR side of healthcare IT and will stick to the medical devices and mHealth devices that fit under the medical device term. I think this is generally a good thing for a number of reasons. Not the least of which is that the FDA doesn’t have the expertise needed to regulate EHR software. However, I wouldn’t mind a touch more patient safety concern from EHR vendors. Maybe the EHR Code of Conduct will help add a little more to this concern.

Of course, as Shahid points out, you don’t have to sacrifice agile software development to develop safety critical software. This is true in medical device development, EHR development, and even mHealth development.

June 21, 2013 I Written By

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

Apps Open Up a New World of Health Value

Parents, do you remember the days before smart devices? The days before you could hand your kid a tablet or phone in exchange for at least 20 minutes of uninterrupted quiet? I hope I’m not alone in the personal love/hate relationship I have with smart devices. One minute I find myself using them as a virtual babysitter just to get through a conference call at home. The next, I find myself wishing I could program them to shut off after 20 minutes so that my kids (and my husband) don’t wind up looking like the “humans” in Wall*e. (I’ve heard the Kindle Fire has this option. Anyone know if an iPad can be made to do the same?)

Parental musings aside, I believe smart devices certainly do have their part to play when it comes to educating or even conditioning healthcare consumers, especially in the area of gamification. This point was driven home when I overheard my oldest say to my youngest as they played on the iPad, “Your health value isn’t high enough. You need to add more broccoli.”

smoothiemaster

“Smoothie Master” from TabTale was their game of choice. As the name implies, they were tasked with becoming masters of smoothie creation. I’m still not sure if this game is winnable in the traditional sense, but my seven year-old did explain to me that you could win points for adding healthy ingredients.

TabTale doesn’t seem particularly invested in promoting a healthy lifestyle, as it also has similar apps for mastering the art of making pizzas and hamburgers. But, their inclusion of a health value scoring system does make me wonder if this younger generation will grow up with an inherent sense of what behaviors will keep them healthy in real life. (The irony being that all the broccoli in the world won’t do them any good if they stay glued to the devices that are helping provide this type of education.)

Now, if I can just figure out a way to “gamify” the health value of the broccoli I fix at home so that my kids will eat it and think they have “won.” Let me know in the comments below if you’ve figured out a way to take virtual culinary successes offline and into the real world of kid-friendly cuisine.

May 16, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

ACO Tire Change Analogy

I was at an ACO conference a while back and one of the speakers compared the idea of ACOs to a tire change. Although, he suggested in an ACO world, you’d get your tire changed and then a mile down the road the tire goes flat and the tire company will say they couldn’t predict that to happen.

It’s an interesting comparison to consider. I know many doctors are concerned with ACOs for situations like the one described. This is particularly true because they only have so much control over the health of a patient. Using the car analogy, they don’t know if the person is going to go off roading with their car (risky behavior), run over a nail (get in an accident), or slash the tire themselves (smoking or other unhealthy behavior). Yet, in an ACO world, the doctor is held accountable for all of these things.

I don’t pretend to be the foremost authority on ACOs. I’m still learning (and so is everyone at this point). However, there are some real challenges associated with reimbursing based on improving the health of a patient so they don’t return to the office.

Certainly technology can play a major role in making this happen. In fact, without technology this is a really hard thing to do. Mobile devices can help patients be more accountable for the choices they make. They can help a doctor influence healthy behavior in ways that weren’t possible before.

Big data can help a healthcare organization know which patient populations need the most attention to be able to increase the overall health of a population. Plus, this is only going to get more powerful as patients start tracking their health data more and more and healthcare can address those who have the most need before they even know they need it.

I like the direction that we’re headed in healthcare where we try and reimburse for the right things, but it’s going to be a really long, hard road. In fact, as I look into the future of ACOs I don’t really see a road at all. Instead, I see the ACO movement as trailblazing its way to an unknown future.

March 25, 2013 I Written By

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

Android’s Advantage Over iPhone in Mobile Health Applications

The reports are all over the web comparing the Android market share to iPhone’s market share (see one example here). These numbers are important for anyone in the mobile health space that’s considering their strategy for developing a mobile health application. The same goes for EHR vendors that are working on their mobile EHR strategy.

The reality as I see the mobile phone market share numbers is that Android is taking the lead when it comes to market share. No doubt, iPhone still has an incredibly compelling offering and many loyal fans. This is particularly true in healthcare where a doctor having an iPhone is in many ways a bit of a cool “status” symbol for the doctor. However, in the long term I think that even healthcare will see a similar market share shift to the Android over the iPhone as well.

Why am I so bullish on the Android in healthcare despite healthcare’s current love affair with the iPhone?

The core reason that I think the Android phones (and much of this could apply to tablets as well) will do very well as mobile health applications is because of how much customization is possible with Android devices. In fact, pretty much anything is possible on an Android phone because of the open source nature of the software. I expect many mobile health applications will need and want to exploit the flexibility and openness of Android over the iPhone.

One concern I do have about this idea is that Android does pose its own challenges for developers. In the case of the iPhone, you basically only have to code your application to work across a small handful of iOS versions and handsets. In fact, Apple has smartly made sure that many things remained the same across every iPhone. This makes developers lives much easier. In the case of Android, you have hundreds of possible handset combinations you have to consider when developing your application. This can be really hard to test and can often lead to a bad user experience for some Android devices.

In some ways, the current Android environment reminds me of the challenges we use to face (and still do today in some ways) in creating a webpage that worked across all the various web browsers. A lot of effort went into making sure your website worked everywhere. However, over time the standards have developed and this is much less of an issue today than it was when the internet first started. I believe the same will be true for Android.

The reality is that Android and iPhones are both here to stay for the foreseeable future. Most mobile health applications are going to have to be able to support both platforms. Some might say that we should just be glad that it’s only two platforms we have to worry about. We had a lot more than two to think about back during the internet browser wars.

February 7, 2013 I Written By

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

The Fiscal Cliff of Primary Care and Jubilee Health Community – Around Healthcare Scene

EMR AND HIPAA

The Fiscal Cliff of Primary Care

Everyone has heard about the Fiscal Cliff that is currently being talked about at the White House, but have you heard about the fiscal cliff of primary care? The Hello Health Blog posted some interesting facts about what they refer to as the fiscal cliff of primary care. At the core of the discussion is whether or not EHR software is a financial win or loss.

Mobile Health Trends and Technology

This post features videos that were taken at the mHealth Summit in Washington D.C. The videos are interviews with various people and describe some of the up and coming mobile health trends and technology. David Collins and Jonathan Dreyer talk about different trends they have seen, and provide a perspective on health applications.

Hospital EMR and EHR

Impossible to Say “Wrong EHR”

The title of this isn’t always true — it is possible for a hospital to have implemented the wrong EHR. However, it’s a hard mistake to admit. Especially with EHRs like Epic, which are highly selective and cost so much money.

Oops! Community Hospitals Unhappy with EMR Purchase

The latest KLAS reports revealed that many community hospitals are disappointed with their EMR, and questioning the purchase. Some of the hospitals are even pulling the systems completely from their practice. This may not be the best solution, but some of these hospitals don’t feel like it is worth the time and effort.

Smart Phone Health Care

Jubilee Health Community and NoMoreClipboard Combine Forces To Help Diabetes Patients

Diabetes is very prevalent in the United States today, and it can be difficult to manage. Jubilee Health Community provided NoMoreClipboard with someone of their diabetic patients to help treat and manage their diabetes. After a year, some interesting results were found. In some cases, the health of a patient who actively used the system increased.

December 23, 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.

Biggest mHealth Issue

I’ve spent the past couple days enjoying the flow of mHealth information from some of the leaders in mobile health at the mHealth Summit. It’s been a great experience and I can tell you that HIMSS acquisition of mHealth Summit has been a very good thing for the conference.

As I think back on the conference, a few tweet highlighted the largest issue facing mHealth today.

I’ve heard this over and over this week. Helping doctors and patients trust mobile health is an enormous challenge. The mobile health apps and device area is exploding with companies and products. However, there is very little evidence of the benefits of the various mobile health products. Most of what mobile health has is anecdotal.

In fact, another tweet highlighted how to solve the problem of trust in mHealth:

The concept is that mHealth is innovating so fast that most of the research methodologies that have been ingrained in healthcare take so long to show results that the technology will have moved so far past the features verified in the study.

I’m not sure the solution to this, but we need to discover new research methodologies that can prove efficacy and quality of mHealth at a fast enough pace that the technology doesn’t render that study irrelevant. If we can do this, then we can build the trust component of mobile health technologies.

December 5, 2012 I Written By

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

60 Minutes EHR Story, EMR Disconnect, and EMR Erector Set


I don’t know how many other people watched the 60 Minutes healthcare story tonight. It will be up on CBS.com tomorrow if you’re interested in seeing it. While, EHR wasn’t the complete focus of the story, it played a large part in the second half when it comes to trying to get doctors to admit more patients to the hospital. The core of the story was more around whether hospitals should set admission goals.

I’ll leave the admission goals to other healthcare people. When it comes to EHR suggesting admitting a patient, you’re walking a fine line. The future of EHR is going to be more artificial intelligence that works to inform the doctor in the process of giving care. This could certainly include standards of care which could include admitting a patient to the hospital based on an evidence based standard of care. I don’t think most doctors have any problem with this type of EHR suggestion as long as the doctor can also make an informed override of the suggestion.

In the 60 Minutes story they suggested that Health Management Associates (HMA) would “punish” those doctors who used the override when a hospital admission was suggested. Reviewing overrides is reasonable and acceptable, but when punishment is due to hospital revenue it crosses the line. This is what was suggested by the 60 Minutes story.

The other thing not discussed in the story is whether the hospital admission prompt in the EHR was created around evidence based medicine or if it was created around revenue plans. One ED doctor suggested the hospital admission alert was done by a non-doctor with no medical training. I’d be interested to learn more about how the hospital admission alerts were really created.

I’m sure we’re going to see a lot more discussion coming out of this 60 Minutes story on Health Management Associates (HMA).


This was an interesting tweet that displays the need in this highly connected world to be able to disconnect. I agree this is a problem, but I don’t think the technology is the problem. It’s the expectation that’s the problem. Once you deal with the expectation issues, then the technology is a benefit and not a weight on your life.


I heard someone else in the mHealth Summit Twitter hashtag talk about mHealth being a toddler when it comes to how far its developed. We’re probably only a 7-8 year old in the EHR world. So many more opportunities available for healthcare.

December 2, 2012 I Written By

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