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CA EMR Adoption Up, But Other Health IT Use Is Behind

Posted on November 18, 2013 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.

While California providers are stepping up their use of EMRs, they’re still behind on some other measures of health IT adoption, according to a new report by the California HealthCare Foundation.

First, the positives. California physicians who use EMRs grew from 37 percent in 2008 to 59 percent in 2013. The report also concluded that 50 percent of California hospitals used EMRs in 2012, compared with 13 percent in 2007, and that 65 percent of community health centers used EMRs in 2011, compared with 3 percent in 2005.

All that being said, California providers are behind when it comes to Meaningful Use. While 58 percent of them said in 2012 that they planned to participate in Meaningful Use, only 30 percent of California providers with EMRs had a system that met all of the program’s 12 objectives, notes iHealthBeat.

What’s more, California hospitals’ use of clinical support systems fell from 77 percent in 2010 to 71 percent in 2012, a pretty low number given that the national average of 97 percent use of such tools. Also, the state ranks 49th in the country for e-prescribing rates.

The researchers also note that providers seem less interested in health IT than consumers. The 57 percent of state residents who had access to their EMRs  used them to view their health records, e-mail physicians and schedule care appointments, iHealthBeat reported.

All told, the report comes as something of a surprise, given that over time, California has traditionally been at the leading edge of many healthcare industry trends. And it suggests that many California providers are missing out on increasingly well-documented opportunities to improve productivity. So let’s hope that traditionally cutting-edge providers take the nudge provided by this report seriously.

Atlanta Hospital Sues Exec Over Allegedly Stolen Health Data

Posted on November 1, 2013 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 most cases of hospital data theft, you usually learn that a laptop was stolen or a PC hacked. But in this case, a hospital is claiming that one of its executives stole a wide array of data from the facility, according to the Atlanta Business Chronicle.

In a complaint filed last week in Atlanta federal court, Children’s Healthcare of Atlanta asserts that corporate audit advisor Sharon McCray stole a boatload of proprietary information. The list of compromised data includes PHI of children, DEA numbers, health provider license numbers for over 500 healthcare providers, financial information and more, the newspaper reports.

According to the Children’s complaint, McCray announced her resignation on October 16th, then on the 18th, began e-mailing the information to herself using a personal account. On the 21st, Children’s cut off her access to her corporate e-mail account, and the next day she was fired.

Not surprisingly, Children’s has demanded that McCray return the information, but as of the date of the filing, McCray had neither returned or destroyed the data nor permitted Children’s to inspect her personal computer, the hospital says. Children’s is asking a federal judge to force McCray to give back the information.

According to IT security firm Redspin, nearly 60 percent of the PHI breaches reported to HHS under notification rules involved a business associate, and 67 percent were the result of theft or loss. In other words, theft by an executive with the facility — if that is indeed what happened — is still an unusual occurrence.

But given the high commercial value of the PHI and medical practitioner data, I wouldn’t be surprised if hospital execs were tempted into theft. Hospitals are just going to have to monitor execs as closely they do front-line employees.

China’s EMR Market

Posted on October 30, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Last week I wrote about what’s not happening in China: American firms getting a slice of the EMR market.

This time I thought it’d be interesting to look at what is happening with health IT in the world’s most populous country.

As I mentioned, that’s often easier said than done. The healthcare system has peculiarities, and the government doesn’t necessarily say what it’s planning. Some research firms have shied away from reporting on China’s EMR scene altogether.

But a case study released over the summer provides some fascinating market intelligence. The work by Arthur Daemmrich, associate professor at the University of Kansas School of Medicine, follows Shanghai Kingstar Winning Software Co. Ltd. as its founder seeks to increase its growth rate.

Three options that Zhou Wei was considering as the first quarter of 2013 drew to a close included continuing to grow organically, merging with another company and expanding into other geographies, including South Asia or even the United States.

Points worth noting:

  • Winning, with 1,000 employees, competed for hospital IT projects with five other large firms. A few hundred smaller companies provided more specialized offerings.
  • The government owned more than 90 percent of the country’s hospitals.
  • Winning had achieved 50 percent revenue growth in 2012 and expected the same in 2013, but Zhou was not satisfied. He felt that even more rapid growth was needed.
  • In 2008, 1 percent of China’s hospitals were using EMRs. By 2012, about 32 percent of higher-ranked hospitals — tier-II and tier-III institutions — had EMRs.
  • Medical record-keeping in China came nearly to a halt during World War II and the country’s civil war. Many leftover records were destroyed during the Cultural Revolution of the 1960s and 1970s. The country then began rebuilding its records infrastructure. Daemmrich wrote, “Outpatient visits and prescriptions were recorded on small booklets that patients kept and brought with them to the hospital or other specialized clinic. Most hospitals issued their own booklets, so patients could end up with several different sets of medical records at home.”
  • Zhou’s firm undertook a project at an 850-bed Chinese traditional medicine (TCM) hospital. At such institutions, treatments such as acupuncture and therapeutic massage are common. The company’s R&D director, Ma Wei Min, explained, “The interfaces of western medicine and TCM EMR systems are alike, because the patient flow paths at both kinds of hospitals are almost the same. But going back to the software writing stage, TCM EMRs required a different logic and very different terminology.”

It’s easy to get immersed in the health IT considerations of our own country and forget that other regions are undertaking similar efforts. In China, the goals of the EMR push are largely the same as they are in the United States, but it’s interesting how much local flavor comes into play. The fact that Winning’s founder was seeing 50 percent revenue growth but still expected more was amazing and speaks to the country’s pace of economic development. And the background on China’s record-keeping shows that the country’s task is not just to digitize processes that have long been in place, but to define exactly what a medical record is and how it should work.

4 Reasons U.S. EMR Firms Won’t Try China

Posted on October 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

If you have something to sell, chances are you’ve thought about selling it in China.

With a population of 1.35 billion, it’s become an attractive market for U.S. companies pushing everything from athletic shoes to light trucks to Tide. Given the natural limits of their home market, you’d assume that American EMR firms would eventually size up China’s nascent health IT scene.

And it’s likely they have. In a report a few years ago, 100 percent of vendors surveyed told the consulting firm Accenture that they saw global markets as an opportunity in the long term.

But health IT doesn’t export quite as easily as Pringles and KFC. I’ve seen China’s healthcare system up close several times, and if you ask me, making headway in the world’s most populous nation will be beyond difficult.

China, which is in the midst of its own health care reform, could certainly be tempting for companies such as Epic, McKesson and Cerner. As Benjamin Shobert wrote for Forbes, the country in 2009 extended basic health coverage to 97 percent of its citizens. It also promised to build 31,000 hospitals, upgrade 5,000 existing ones and train 150,000 new primary-care doctors.

McKinsey & Co. last year said health care spending in China would grow to $1 trillion in 2020 from $375 million in 2011.

Meanwhile, U.S. EMR companies are going to need new markets to conquer. Estimates of how much growth potential is left are many and varied. But no matter how you look at it, at some point every American healthcare organization of any size will have an EMR. Millennium Research Group last month predicted declining EMR-industry revenue from this year on because of “market saturation.”

Of course, plenty of IT firms, including Oracle and IBM, have a major presence in China. But the China market won’t happen in a significant way for U.S. health IT companies any time soon, and here’s why:

  • China’s healthcare is different. The private physician’s office that Americans are used to is more or less nonexistent. You go to a hospital-based clinic and see the doctor who’s available. Patient privacy hasn’t taken hold, so there could be other clinic-goers and family members milling about near — or in — your exam room. Chinese traditional medicine is practiced alongside the “Western” variety. Even with insurance, you typically pay up front and get reimbursed later. A U.S.-centric EMR would not map neatly onto China’s workflows. There’s an overview of China’s system here. I’ve written about a Chinese dental clinic here.
  • No one understands China’s health IT. OK, I’m sure some people do, and I hope they comment. But it’s a challenge. The health information firm KLAS Enterprises isn’t even attempting to cover China. A KLAS executive vice president, Jared Peterson, told Modern Healthcare, “The Chinese market, that’s a big mystery.” Meanwhile, Accenture omitted China from its 2010 report “Overview of International EMR/EHR Markets” because of “conflicting opinions of overall EMR maturity.”
  • The language barrier will be formidable. Epic CEO Judith Faulkner told Modern Healthcare how her company had adapted its system for another language. “We’ve only done it once, for Dutch,” she said in January 2012. “It’s a lot of mapping. It’s a task, but it hasn’t been that bad of a task.” But Dutch is not Chinese, and Chinese doesn’t use the Roman alphabet. I’m betting that when you throw Chinese characters into the mix, the conversion will be “that bad of a task” and then some.
  • Cloud-based systems could raise security issues. Some experts expect cloud-based services to play a significant role as health IT spreads to developing countries. But according to a U.S.-China Economic and Security Review Commission report, “Regulations requiring foreign firms to enter into joint cooperative arrangements with Chinese companies in order to offer cloud computing services may jeopardize the foreign firms’ information security arrangements.”

It’s worth mentioning that three years ago, China was mentioned as Cerner announced plans to develop global markets. It wanted to get into emerging regions before its U.S.-based competitors did.

There’s not much sign of life now in any China-related plans the company might have had, though. According to a message from Chad Haynes, managing director for Cerner Asia, on the firm’s website: “We look forward to improving the health of communities in ASEAN, China, and beyond.”

In the case of China, that could be a while.

Healthcare Cloud Spending To Ramp Up Over Next Few Years

Posted on October 4, 2013 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.

For years, healthcare IT executives have wrestled with the idea of deploying cloud services, concerned that the cloud would not offer enough security for their data. However, a new study suggests that this trend is shifting direction.

A new study by market research firm MarketsandMarkets has concluded that the healthcare industry will invest $5.4 billion in cloud computing by 2017.  This year should see a particularly big change, with total healthcare cloud investment moving from 4 percent to 20.5 percent of the industry, according to an article in the Cloud Times.

The current US cloud market for healthcare is dominated by SaaS vendors such as CareCloud, Carestream Health and Merge Healthcare, according to MarketsandMarkets. These vendors are tapping into an overall cloud computing market which should grow at a combined annual growth rate of 20.5 percent between 2012 and 2017, the researchers say.

As the report notes, there are good reasons why healthcare IT leaders are taking a closer look at cloud computing. For example, the cloud offers easy access to high-performance computing and high-volume storage, access which would be very costly to duplicate with on-premise computing.

On the other hand, the MarketsandMarkets researchers admit, healthcare still has particularly stringent data security requirements, and a need for strict confidentiality, access control and long-term data storage. Cloud vendors will need to offer services and products which meet these unique needs, and just as importantly, change and adapt as regulatory requirements shift. And they’ll have to have an impeccable reputation.

That last item — the cloud vendor’s reputation — will play a major role in the coming shift to cloud-based deployments. If giants like AT&T, IBM and Verizon stay in the healthcare cloud business, which seems likely to me, then healthcare institutions will be able to admit that they’re engaged in cloud deployments without suffering a public black eye over potential security problems.

On the other hand, if the giants were to get cold feet, cloud adoption would probably slow substantially, and remain at the trickle it has been for several years. While vendors like Merge and Carestream may be doing well, I’d argue that the presence of the 2,000-pound gorilla vendors ultimately dictates whether a market thrives.

Eyes Wide Shut – Is This Meaningful Use?

Posted on September 25, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Again and again, I find myself expounding upon the need to differentiate between the “letter of the law” and the “spirit of the law” of Meaningful Use Stage 2. I believe whole-heartedly in the transformative power of health IT, and support the future vision of the Meaningful Use objectives of patient empowerment and nationwide standards for records transmission and interoperability. The spirit of the “law” is a revolutionary movement towards a technology-enabled, patient-centric healthcare system, where clinical data can be shared and consumed instantly, whenever patient desires or requires it.

The letter of the “law” is daunting, and its implementation could be seen as not only counter-revolutionary, but detrimental to the very patient population it is designed to engage and empower.

Consider this acute care scenario:

You’re a hospital healthcare provider, discharging a patient, in compliance with the patient-specific education and Summary of Care measures. You log in to your EMR, complete the discharge instructions in the correlated workflow, print the discharge summary and any condition-specific educational information for the patient, revisit their room to insure that they can review the instructions and ask any questions, and you’re on to assessing the condition of the next patient in need of care. Right?

How many times did you have to close the “patient-specific education” suggestion windows that popped up, alerting you to available materials for download, keyed off diagnosis codes or lab results?

How many minutes did you spend looking for the HISP address of the patient’s cardiologist, so you could transmit the Summary of Care document to them via the Direct module of your EMR? How many clicks did you have to use to FIND the Direct module in your EMR? And how many minutes did you spend cursing the ONC for requiring Direct for Summary of Care transmission for 10% of your discharged patient population when the cardiologist’s address was rejected by the Direct module, giving you a message that the receiver is not DirectTrust-accredited?

How much time did the discharge process take you before your facility decided to attest to Meaningful Use Stage 2? How much time does it take you now?
Consider this ambulatory care scenario:

You’re support staff for a general practitioner, who is deploying a patient portal in support of patient engagement measures. At check-in (or check-out), you provide the patients with the URL for enrollment and access, give them information on the benefits of having their medical records available electronically, encourage them to communicate electronically with their provider with questions or concerns, and you send them on their empowered and engaged way.

How many minutes did you spend validating each portal account owner’s identity once their enrollment request came? How many minutes did you spend validating the relationship of the portal account owner to each of the patients he/she requests to associate with the account? How did you document the due diligence done to insure no medical records are improperly released per HIPAA and other federal guidelines, as in the case of custodial disputes, behavioral health patients, or emancipated minors?

How many minutes did you spend walking patients through the enrollment, login, medical records view, and secure message functions? How much time did you spend answering questions from patients about the portal, rather than the health concerns that prompted the visit?

How much time did the check-out process take before your GP decided to attest to Meaningful Use Stage 2? How much time does it take you now?

In both of these scenarios, did you or the patient see any measurable difference in care as a result of the EMR’s new functionality?

Now, consider the aggregate of these scenarios over an entire day – dozens of encounters, dozens of clicks, dozens of minutes spent engaging the EMR to record requisite “clicks” for attestation numerator reporting, rather than engaging the patient.

Is this meaningful use of a healthcare provider’s time and energy? Is this meaningful use of health IT, meeting very specific targets to obtain finite objectives rather than enabling innovation and deriving best practice long-term solutions?

Is this what the ONC intended?

Are State Health Agencies Ready for Meaningful Use Stage 2?

Posted on September 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

As part of its public health objectives, Meaningful Use 2 requires doctors and hospitals to report sizable amounts of information.

The idea is that when significant patterns are forming — an outbreak of a certain disease, for example, or a peculiar cluster of symptoms — they’ll be apparent right away.

But someone has to be in position to receive the data.

The responsibility falls to local and public health departments. Agencies around the country should, theoretically, be preparing for the immunization records, laboratory results and other information they’ll soon be getting.

Just how many will be ready, though, remains to be seen. Many cash-strapped departments lack the IT infrastructure for what’s being asked of them — and the money allocated by the government hasn’t amounted to much, according to a 2012 American Journal of Public Health article by Drs. Leslie Lenert and David Sundwall.

In fact, the authors wrote, the federal effort “has created unfunded mandates that worsen financial strains” on health departments.

There’s a caveat, though: The mandates aren’t really mandates.

“Nothing compels them to do it” except the desire to do the right thing, said Frieda du Toit, owner of Lakeside, Calif.-based Advanced Business Software. “Some directors are interested, some are not. The lack of money is the main thing.”

In our recent interview, du Toit, whose company specializes in information management solutions for health departments, added: “One customer asked me: ‘Am I going to be punished in any way, form or fashion if I don’t support the efforts of my hospitals and care providers?”

Her firm’s Web-based Public Health Information Management System serves cities and counties throughout the United States, including in California, Texas and Connecticut.

The federal government’s goal is for public health agencies to be involved in four administrative tasks to support MU2, according to the Stage 2 Meaningful Use Public Health Reporting Task Force. The task force is a collaboration between the U.S. Centers for Disease Control and Prevention, nonprofit public health associations and public health practitioners.

The first step is to take place before the start of MU2 — that’s Oct. 1, 2013, for hospitals and Jan. 1, 2014, for individual providers.

The tasks:

  • Declaration of readiness. Public health agencies tell the Centers for Medicare & Medicaid Services what public health initiatives they can support.
  • Registration of intent. Hospitals and providers notify public health agencies in writing what objectives they seek to meet.
  • On-boarding. Medical providers work with health departments work to achieve ongoing Meaningful Use data submission.
  • Acknowledgement. Public health agencies inform providers that reportable data has been received.

For doctors and other eligible professionals, MU2 calls for ongoing submission of electronic data for immunizations. Hospitals are to submit not only immunizations but also reportable laboratory results and syndromic surveillance data.

Health care providers whose local public health departments lack the resources to support MU2 are exempt from the reporting requirements.

In Meaningful Use Stage 3, which health IT journalist Neil Versel wrote is likely to begin in 2017, “electronic health records systems with new capabilities, such as the ability to work with public health alerting systems and on-screen ‘buttons’ for submitting case reports to public health, are envisioned,” according to Lenert and Sundwall.

The authors noted: “Public health departments will be required not just to upgrade their systems once, but also to keep up with evolving changes in the clinical care system” prompted by the regulations.

They proposed cloud computing as a better way. Shared systems and remote hosting, Lenert and Sundwall suggested, could get the work done efficiently and affordably, albeit at a cost to individual jurisdictions’ autonomy.

As EMR adoption grows, it would be a shame not to take advantage of the opportunities for public health. The entire health IT effort being pushed by the federal government is, after all, geared toward improving the health of populations.

Without money for the job, though, public health agencies’ ability to support Meaningful Use will likely always be limited. It looks like a good time to think about committing significant funds, embracing cloud-based solutions or both.

EMR Market is Growing, But It’s Not What It Was

Posted on September 11, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The EMR market is likely to grow at more than 7 percent per year through 2016, according to a new report.

The estimate comes from London-based research and advisory firm TechNavio. The company wrote in its analysis, “Global Hospital-based EMR Market 2012-2016,” that “demand for advanced health monitoring systems” and for cloud-computing services were major contributors to demand.

On the other hand, according to the company, implementation costs could be a limiting factor.

The TechNavio figure is actually a compound annual growth rate of 7.46 percent. That means substantial opportunity for the many companies referenced in the report, including Cerner Corp., Epic Systems Corp., AmazingCharts Inc. and NextGen Healthcare, to name a few.

Another research firm, Kalorama Information, in April reported that the EMR market reached nearly $21 billion in 2012, up 15 percent from the year before, driven by hospital upgrades and government incentives.

About 44 percent of U.S. hospitals had at least a basic EHR in 2012, up from 12 percent in 2009, according to the Office of the National Coordinator for Health IT.

In the United States, at least, future growth might require more resources and creativity to achieve. You might remember the recent post “The Golden Era of EHR Adoption is Over,” by Healthcare Scene’s John Lynn, positing that the low-hanging fruit for EMR vendors, the market of early adopters and the “early majority,” is gone, leaving a pool of harder-to-convince customers.

But the TechNavio report is broader, considering not only the Americas but also Europe, the Middle East, Africa and Asia Pacific. That’s truly a mixed bag, as while health IT is at a preliminary stage in many developing markets, it’s highly advanced in countries such as Norway, Australia and the United Kingdom, where, according to the Commonwealth Fund, EMR adoption by primary-care physicians exceeds 90 percent.

When EMR initiatives get a firmer foothold in countries such as China, where cloud-based solutions could well prevail, growth rates for those areas might exceed — several times over — the overall figure predicted by TechNavio.

And in the United States, certain pockets, such as the rural hospital market, still present huge opportunity. Fewer than 35 percent of rural hospitals had at least a basic EMR in 2012, but the enthusiasm is clearly there, as that number was up from only 10 percent in 2010, according to the Robert Wood Johnson Foundation.

It looks like it’s still a great time to be an EMR vendor. But it’s not the same market that it was even a couple of years ago, and success in the new era might require looking at new markets and approaches.

Adding Insult To Injury, Sutter’s Epic EMR Crashes For A Day

Posted on August 30, 2013 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.

The Epic EMR at Northern California’s Sutter Health crashed earlier this week, leaving the system inaccessible for an entire day, reports Healthcare IT News. The system, which cost Sutter nearly $1 billion, went offline at approximately 8AM, locking out doctors, nurses and staff from accessing vital information such as medical lists and patient histories.

The crash followed a few days after planned downtime of eight hours which was scheduled to take place due to implement an upgrade.  During that period nurses could still read med orders and patient histories but had to record new data on paper and re-enter it later into the system, Healthcare IT News notes.

During the unplanned outage this week, the Epic system was offline at several Sutter locations, including Alta Bates Summit Medical Center, Eden Medical Center, Mills-Peninsula Hospital, Sutter Delta, Sutter Tracy, Sutter Modesto along with several affiliated clinics, the magazine said.

The outage drew the ire of the California Nurses Association, which called this incident “especially worrisome.” But the CNA notes that the crash is hardly the first time there’s been a concern over the Epic rollout. Nurses at Sutter have been complaining for months about alleged safety problems with the Epic system, notes the Sacramento Business Journal.

According to the CNA, more than 100 nurses had previously filed complaints at Alta Bates Summit, arguing that the Epic system was hard to use, and that computer-related delays had adversely affected the ability of nurses to monitor patients properly.

Sutter nurses’ complaints included the following:

• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.
• A nurse who was not able to obtain needed blood for an emergent medical emergency.
• Insulin orders set erroneously by the software.
• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.
• Lab tests not done in a timely manner.
• Frequent short staffing caused by time RNs have to spend with the computers.
• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.
• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.
• Patient information, including vital signs, missing in the computer software.
• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.
• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.
• Inadequate RN training and orientation.

Sutter officials, for their part, are not having any of it. Hospital spokeswomen Carolyn Kemp called the allegations that Epic was causing problems “shameful,” and argued that the accusations are arising because the hospital system is involved in a labor dispute with the CNA.

Meanwhile, Sutter execs are turning up the heat on nurses whom they feel aren’t using the EMR properly. According to Healthcare IT News, leaders have been scolding nurses whom they believe have not been entering all billable services into the EMR, which resulted in a loss of $6,000 in a single week, according to a July memo obtained by HIN.

Sutter’s spokesperson, Bill Gleeson, offered this official response:

Sutter Health undertook a long-planned, routine upgrade of its electronic health record over the weekend. There’s a certain amount of scheduled downtime associated with these upgrades, and the process was successfully completed. On Monday morning, we experienced an issue with the software that manages user access to the EHR. This caused intermittent access challenges in some locations. Our team applied a software patch Monday night to resolve the issue and restore access. Our caregivers and office staff have established and comprehensive processes that they follow when the EHR is offline. They followed these procedures. Patient records were always secure and intact. Prior to Monday’s temporary access issue, our uptime percentage was an impressive 99.4 percent with these systems that operate 24/7. We appreciate the hard work of our caregivers and support staff to follow our routine back-up processes, and we regret any inconvenience this may have caused patients. California Nurse Union continues to oppose the use of information technology in health care but we and other health care provider organizations demonstrate daily that it can be used to improve patient care, convenience and access. While it’s unfortunate the union exploited and misrepresented this situation, it comes as no surprise given the fact that we are in a protracted labor dispute with CNA.

Without This EMR Step, You Might Never Get It Right

Posted on August 29, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

It’s not hard to find physicians and nurses who say that far from improving health care, the EMRs they use are something to work around.

Billing problems, lost productivity and even diminished quality of care are common complaints, sometimes long after the implementation kinks should have been worked out. In some cases, doctors who bought into EMRs as a way to operate more effectively and efficiently have found themselves disappointed enough to look for hospital employment, try new practice models or even close their doors, as HealthcareScene.com founder John Lynn has written.

Often the problem lies deeper than the technology, according to a recent white paper from TechSolve, a Cincinnati-based consulting group. After all, an electronic overlay does little good when it serves only to automate bad processes.

TechSolve is promoting a process-mapping approach to EMR for hospitals through its Lean Healthcare Solutions unit. It’s part of a trend toward applying the efficiency techniques of Japanese manufacturers to EMRs and other aspects of health care.

Like Toyota and other pioneers of lean, health care providers should rely on line workers to help root out waste, according to TechSolve.

“While you may be inclined to dismiss negative comments as resistance to change, staff may be aware of design issues that the design team, PI facilitator, and vendor were not,” TechSolve consultants Sue Kozlowski and Alex Jones wrote.

They offered seven steps to ensure maximum benefit from an EMR, a few of which I’ll share. I suggest downloading the full paper for a complete view.

TechSolve recommends thinking about process improvement before getting started with an EMR. Of course, if it’s too late for that, the firm and others in the space are happy to step in later, as well.

Here’s what TechSolve advises:

  • Map your current processes. This can be done with help from your process improvement team or an outside group. In some cases, it’s best to assign a team to each service line.
  • Compare current and future states. Color-coding is one way to do this, highlighting visually for staff members how their work will change.
  • Prioritize issues that affect patient care and payment timing. An “issues list” can be created and then reviewed after “go live” to make sure problems have been corrected. Also, examine how well staff members are adhering to the new processes, asking questions such as, “Where are they using work-arounds, and where have they found new capabilities in the system?”
  • Process map again. This new snapshot is the baseline going forward. It can serve as a reference for staff members when they’re in doubt and as a training tool for new hires.

We’re all looking for technology that makes our lives easier right away. But when it comes to EMRs, there’s no true turnkey solution. Making a system pay off requires investments, particularly of time, well beyond the sticker price.

Under traditional reimbursement models, though, planning is not what brings in the revenue. It’s easy enough to see why hospital employment, with guarantees of a salary and IT assistance, is becoming a more and more attractive option for physicians who want to limit expenses and risk.

Hospitals, though, have no plan B. They’ll have to marry their IT to efficient processes or else.