Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Partners Health Care Not to Expand – Can’t We All Just Get Along?

Posted on February 6, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

So the deal is off for the mega-medical conglomerate that dominates Boston’s health care scene. Partners Healthcare, which came so close to buying up several competitors, got slammed by a newly installed attorney general and a judge presiding over the merger decision. So big is Partners in health care–and health care in the Boston market–that this news made the lead headline in the Boston Globe on January 30.

Partners may go ahead with the mergers and face a lawsuit, but my guess is that they’ll sense the trending of the political tides and back away. Everyone understands that dominant health care providers tend to raise costs–but what might we have lost in preventing the merger?
Read more..

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 .

Is Remote Monitoring Data A Blessing, Or A Distraction?

Posted on August 1, 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.

This week, Venture Beat reported on some growing remote monitoring efforts in which a handful of Massachusetts hospitals are working to pull the data into their EMR. The hospitals are hoping to get their arms around a growing body of data which increasingly lives not only in wireless medical devices (such as glucometers and pulse oximeters) but also smartphones, smart wristbands, FitBit devices and other health-tracking technology.

One of the players involved in the new effort is Partners HealthCare, whose Center for Connected Health is focused on collecting and making use of such data. Its latest initiative sweeps patient data collected at home — such as blood pressure, weight and blood glucose — into the Partners EMR, making it accessible as part of routine clinical workflow. (The data collected by patients is transmitted wirelessly and automatically subsumed into the EMR.)  Patients can also review the data through a patient portal known as Patient Gateway.

According to Partners, this process is designed to change care delivery by allowing doctors to keep a close watch on patients when they’re not in the hospital or doctor’s office.

This is all well and good, especially for monitoring the chronically ill, whose condition may fluctuate dangerously and require timely intervention. But the question is, is this new flood of data going to be manageable for doctors?  Can a physician managing thousands of patients really give appropriate attention to every data point a FitBit or smartphone produces?  Certainly not.

Perhaps that’s why Kaiser Permanente recently told a conference that it was going to be rather picky as to what data flows into its EMR. According to Lead Innovation Designer Christine Folck:

“Don’t come to us telling us you can upload [data] into our electronic medical record. We don’t necessarily want it there. We have too much information in our electronic medical record. Kaiser Permanente was one of the first to go nationwide with our electronic medical record, we are fully integrated, but the problem is now everybody wants to upload into it. Our physicians don’t want it all there. They really don’t need to know how much exercise each of their patients is getting on a daily basis; they just don’t have time to process all of that.”

So, while there’s clearly benefit to tracking chronic conditions via remote monitoring, it seems clear that there will be some pushback from doctors, who can’t possibly absorb all of the data the healthier “quantified self” types are producing.  It looks to me like we’re going to have to narrow down what categories of data are actually helpful in an EMR and which aren’t.

Partners Integrates Mobile Data With EMR

Posted on June 25, 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.

In a move that could realize much of the promise of wireless remote monitoring, Partners HealthCare system has made it possible for providers to view remotely-collected patient health data in its EMR.  The program was launched by Partners division The Center for Connected Health, which focuses on delivering new forms of patient care outside of standard medical settings.

For years, Partners has been running programs which collect patient data through a combination of remote-monitoring technology, sensors and Web-based tools. Their focus has included management of chronic diseases such as diabetes and high blood pressure, medication adherence and improved pregnancy outcomes and cardiac care outcomes. The Center’s remote monitoring database now stores over 1.2 million  patient vital signs.

Now, Partners has linked The Center’s proprietary remote monitoring database to its EMR, a step which moves the system in the direction of offering continuous chronic disease management. If a patient is participating in a remote monitoring program, Partners physicians can can now see a patient’s day-to-day vital signs, blood glucose levels, weight and other key health indicators directly within their records in the EMR.

The ultimate notion, according to the press release at least, is to  “put the patient at the center of their care while maintaining a close watch on their condition when they are not in the hospital or doctor’s office.”

While Partners didn’t say how many patients are involved in The Center’s programs, it’s doubtless a small fraction of overall Partners patient population. So despite the general coolness of what they’re trying to do, this is still more on the order of an experiment than a population health management program via remote monitoring.

Still, what Partners is doing is a large step in the right direction, and will doubtless realize some of the long anticipated benefits of remote monitoring for patients who are involved. Good show, folks.

Creating The Intelligence-Based EMR

Posted on August 21, 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.

Given today’s trends, I’m betting most of us would agree that EMRs need to evolve from transaction-based to intelligence based systems. They need to do better leveraging “big data,” make context-based care recommendations and support smart processes.  John likes to call them “Smart EMR,” but what would such an EMR look like?

In a recent issue of Hospitals & Health Networks, Dr. John Glaser, Ph.D.,  lays out a long– but useful– explanation as to why EMRs are stiffly focused on transactions such as documenting a visit or writing a prescription. (Very short summary: That’s just where they are coming from historically.)  Then he offers a take on the “intelligence-based EMR” and what it will take to get there.

Glaser, CEO of the Health Services Business for Siemens Healthcare, was formerly VP and CIO for Partners HealthCare, so he’s got both the vendor and the care provider view, which I think proves very useful for this discussion.

In his article, he argues that the next-gen EMR needs to offer the following:

  • foundational sets of templates, guidelines and order sets that reflect the best evidence or established best practice;
  • a process-management infrastructure that supports basic transaction checking such as drug-drug interactions, as well as asynchronous alerting like panic lab reporting and process monitoring and guidance;
  • team-based care support such as shared work lists, as well as tools for patient engagement and health information exchange;
  • novel decision aids like predictive models that can tell us if a particular patient is likely to be readmitted because he or she is fragile or has a substandard social situation at home that may negatively impact healing;
  • context-aware order sets and documentation templates that guide the physician and help infer what types of orders should be placed and what types of documentation should be done
  • intelligent displays of data, intelligent correction and identification of data, and extraction of structure by going through free text and pulling out quality measures or problems that were not previously in a patient’s problem list, for example.

The question is, are these functions science fiction (i.e. many years away from being standard) or just an evolutionary leap from today’s systems?  What are you seeing out there?

So, EMRs Do Reduce Tests Ordered? Partners Says Yes

Posted on April 16, 2012 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.

About the same time last month, I brought your guys some unwelcome news – that physician access to electronic records perhaps doesn’t reduce the number of tests subsequently ordered, and hence doesn’t reduce healthcare costs as much as previously thought.

Except that maybe it does. At least that’s according to an article in Chicago Tribune that summarizes the findings of a study by Partners Healthcare, and a research letter published in the Archives of Internal Medicine (full text, PDF).

According to the study:
– It looked at health information exchange and test data between Mass. General Hospital and Brigham and Women’s over a 5 year period from Jan. 1, 1999 to Dec. 31, 2004.
– The study looked at 117,606 patients during this period. Of these, 346 patients had recent off-site tests, of which 44 were done prior to the HIE rollout.
– The study found that for patients with recent off-site tests, there was a 49% reduction in number of tests ordered.
In number terms, the number of tests ordered per person reduced from 7 in 1999 to 4 in 2004.
– There was however a slight increase in number of tests ordered for the population that didn’t have any prior testing done during the same time period – increasing from 5 per person to 6 per person.

These findings directly contradict the Health Affairs study that I mentioned earlier. The Chicago Tribune article has a little researchers-play-nice subsection at the end where the Health Affairs and Partners researchers try to interpret each other’s contradictory results.

If I may add my 0.02:
– Even though the Partners study follows a larger population of patients, the data that is used to calculate the reduction (346 and 44) is way too small
– The Health Affairs studied some 28,000 patients spread across 1,187 doctor’s offices, while the Partners study followed a larger population of patients at two huge Mass. hospitals that entered into a partnership with each other.

While this not directly discounting anything each group has found, I would think the HA study is more representative of what’s going on in different parts of the country, where doctors are using different (in capability/costs) EMRs and labs to get their results. In Partners case there may well be a tacit agreement on EMR brand, or even tacit trust between the labs/facilities that each hospital uses.

Very interesting though, and I’d really love to see what else comes out on EMR and healthcare costs.

Some Twitter Thoughts from the Connected Health Symposium

Posted on October 20, 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’m busy today and tomorrow at the Connected Health Symposium in Boston. It’s been a pretty interesting event. Instead of generally regurgitating facts, they’re bringing up topics which are new and interesting. You can follow my @techguy Twitter account for more updates or the #chs11 hashtag to read all the coverage.

Here’s a few of my tweets from today to give you an idea of some interesting thoughts from the event.

http://twitter.com/#!/techguy/status/127078090168991745

It’s Official – I’m Attending the Connected Health Symposium in Boston

Posted on September 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.

UPDATE: I’m also going to be doing a healthcare IT event in Boston with ScratchMM if you’re not going to the conference and still want to come meet me. Just register for the event here so we know how many are coming.

I’ve finally finished the plans for my trip to Boston for the 2011 Connected Health Symposium that’s done by Partners Healthcare. The Connected Health Symposium is October 20-21, 2011. I think I’ll enjoy the event.

A quick look at the agenda and the people on the agenda illustrates why I’m excited to attend the event.

The organizers of the event also sent a discount code for $400 off the regular rate for all HealthcareScene.com readers. The coupon code is: HealthcareScene (all one word) and you can register here. Word is that you might even get a special HealthcareScene.com ribbon if you use that code to register.

I’ll have a bit of free time in Boston the day before the event and Thursday evening I may have a little meetup. So, if you’re close to Boston, I’d love to meet you in person and hear your story. It’s always great fun for me to meet the readers of my sites.

This Is Not An Ad For The Connected Health Conference, But Go Anyway, OK?

Posted on April 20, 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.

In October of this year, the very smart people at the Center for Connected Health in Boston will again hold their annual symposium.  And unless I get hit by a bus, I intend to be there and learn everything I can.

While you’ve seen me get flip here from time to time, I’m not joking now.  I think that it’s an event that should be taken dead seriously by essentially anyone who cares about the future of health IT, disease management and e-medicine.  Their mission, which I regard as central to the future of healthcare generally, is as follows:

We are engaging patients, providers and the connected health community to deliver quality care outside of traditional medical settings. Telehealth, remote care and disease management initiatives reflect the opportunities for technology-enabled care programs.

By the way, in case you suspect the same, I’m not endorsing the conference because the center is backed by Partners HealthCare, an IDS backed by hoity-toity names like Mass General Hospital and Brigham and Women’s.   Their Harvard connection isn’t the point.

No, I’m ranting about the Connected Health Symposium because I think it’s exactly where HIT visionaries ought to be spending their time.  Their programs are demonstrating, today, how the living, breathing HIT structure can bring care to where it’s needed in addition to documenting what happens in traditional settings.

There’s too much going on at the Center for me to provide a wealth of detail, but here’s some examples of what it does (summaries borrowed from media announcements):

*  Last summer, the CCH announced the results of a medication adherence study, using a wireless electronic pill bottle to remind patients with high blood pressure to take their medication. The ongoing study measured a 27% higher rate of medication adherence in
patients using Internet connected medication packaging and feedback services compared to controls.

* Another study found that remote online visits with dermatologists, or e-visits, achieved equivalent clinical outcomes for acne patients. Data further revealed that this model of care delivery was popular with participating doctors and patients, ranking e-visits as convenient and time-saving.

* Data from a late 2009 pilot  conducted by the Center suggested that its online diabetes management program, Diabetes Connected Health, may lead to improved patient knowledge, engagement and accountability, as well as improved patient provider communication.

Don’t get me wrong, the industry can’t avoid wrestling with EMR implementation and management efforts even if providers spend a lot more on remote patient monitoring and telemedicine.  Any reasonable long-term vision of a fully-connected U.S. digital health network includes all of these technologies, plus mobile health innovations we probably haven’t even heard of yet.

But in the mean time, c-health is where the rubber meets the road. (If you want to know what c-health is, read the blog written by the Center’s Dr. Joe Kvedar.)

Hoping to meet y’all in October!