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 HIPAA for FREE!!

ROI for EMR: Does It Even Make Sense Now?

Posted on December 20, 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.

There’s a new data point to add to the debate over EMR return on investment.

Norton Healthcare Inc. in Louisville, Ky., has experienced a $12 million increase in federal reimbursement since it started using Epic, Louisville Business First reported. The health system, which operates five hospitals and a network of outpatient sites, is three years into a five-year, $200 million implementation.

Sounds like the beginning of some pretty good ROI. Or does it?

It’s hard to say.

ROI for records systems is notoriously hard to pin down. The word is that many hospitals don’t even try. And they might be onto something.

A revenue boost is a good sign. It’s often a result of improved coding and lower claims denial rates, as Colin Konschak of health care consulting firm Divurgent and Garrett Blair of Norfolk, Va.-based health system Sentara Healthcare recently wrote. And of course, there are the federal incentives for using an EMR — for hospitals, as much as $11 million over four years.

There’s also the rise in productivity that EMRs are expected to cause. At first, an EMR can slow down clinicians’ workflow and cost them and their organization money. But in time, the system could increase productivity.

But revenue is only part of the equation. Cost savings are the more important — and harder to calculate — factor.

Here are a few ways, as described by Konschak and Blair, that EMRs can help hospitals to save:

  • Less need for transcription.

  • Reduced use of staff time for copying and filing.

  • Reduced — often by 50-70 percent — use of preprinted forms.

  • Potentially lower malpractice premiums because of more complete documentation.

Many other potential benefits are probably real but are even less straightforward to measure. Features such as clinical decision support and electronic medical administration records, for example, could lead to reductions in medical errors — the types of mistakes the federal government no longer pays for. But measuring the money you saved from the errors you didn’t make is fairly abstract.

Many hospitals do little if anything to measure the return on their EMR investment, according to a study released by Beacon Partners last year. Healthcare Scene’s John Lynn wrote a few months ago that CIOs likely view the systems as a “necessary requirement of being a hospital today,” somewhat like cleaning supplies. So they don’t see the need to measure ROI.

To me, the “investment” part of ROI suggests that you have a choice. You put money into something now with the hope — but no guarantee — of a payoff later.

Building an imaging center on the edge of town or buying a surgical robot would probably be considered investments. Maintaining your buildings or upgrading your phones would not.

Doing something the government is making you do is not an investment. Given the reimbursement penalties that will eventually kick in for organizations that stick with paper, it’s hard to imagine that many hospital executives see EMR adoption as a matter choice.

The idea of ROI for EMR is probably outdated, a holdover from the days when having a system was optional. Hospital leaders are shopping for EMRs with an eye toward getting the best value for their money — just the way they shop for cleaning supplies, furniture or legal services.

You could say that as a society we’ve invested in the idea of EMRs and that we’re hoping for a payoff in terms of better outcomes and lower costs. But that doesn’t predict much about whether any particular hospital or doctor will see a dollar-and-cents ROI.

At Norton in Louisville, it sounds like they’re happy just to be recovering some of what they’re spending.

“It really does improve the continuity of care,” Norton’s chief medical officer, Dr. Steve Heilman, told Business First.

For now, it sounds like Norton is on track.

(Note: I work for Business First as a freelancer but didn’t write the story linked here.)

It’s Not The Health IT You Choose, But The Way You Talk About It

Posted on December 13, 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.

With system upgrades taking shape across the country, IT is no longer just another another department in the hospital. More than ever, it’s integral to how healthcare organizations work and get paid.

But you don’t always see this shifting landscape reflected in hospitals’ leadership structures or practices.

That’s unfortunate. Getting the most out of  the billions being spent on health IT will require clear vision and skillful communication at the top levels, according to a December article in the Journal of the American Health Information Management Association.

Doctors, nurses and other team members “must understand the nature of the changes—what the result of the changes will be, how their roles and work will be different, and why change is important,” author Tiankai Wang wrote.

Thoughtful language can go a long way toward minimizing staff resistance and making an implementation successful, explained Wang, a professor of health information management at Texas State University.

Leaders should practice “framing” by promoting the benefits of the technology, such as improved outcomes, lower costs and greater efficiency, Wang wrote. They should also use “rhetorical crafting” by using stories, analogies and other devices to make their message resonate.

Rhetorical crafting, according to Wang, “leverages a ‘show, don’t tell’ approach to frame leaders’ message in a form that will connect more easily with staff and help them to embrace the possibilities of the coming change.”

He also advises using words such as “we” and “should” rather than “you” and “must” when talking about IT changes.

At a more fundamental level, though, IT leadership isn’t always valued in healthcare to the extent that other roles are. In 2013, average total cash compensation for chief information officers was eighth-highest of all hospital titles at about $316,000, Modern Healthcare reported.

And despite the growing importance of health IT, it’s also uncommon for hospital CIOs to be promoted to the roles of chief operating officer, president or CEO.

It does happen, though, as David Raths wrote in Healthcare Informatics. In perhaps the best known example, Cincinnati-based Mercy Health, which operates several hospitals, earlier this year named Yousuf Ahmad, who had previously served as CIO, to the chief executive role. Ahmad had also held other management roles, including president of the system’s physician group.

It’s likely a sign of the front-and-center role that IT is now taking at healthcare organizations everywhere.

EHR Helps Researchers Find Genetic Connections To Disease

Posted on December 5, 2013 I Written By

Anne Zieger 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.

A group of researchers have completed a study which found new links between patients’ genetic profile and specific diseases by mining EMR data, reports a story in iHealthBeat.

The research, which was conducted by the Electronic Medical Records and Genomics Network, a consortium of medical research institutions including the Mayo Clinic and Vanderbilt University School of Medicine, analyzed data from about 13,000 of EMRs.

The participants then grouped about 15,000 billing codes contained in the EMRs into 1,600 disease categories. Next, they looked for links to diseases in EMRs which contained DNA data.

The researchers, whose study was published in the journal Nature Biotechnology, found  63 new genetic links to diseases, ranging from skin cancer to anemia, iHealthBeat said.

The EMR study method, which is known as a phenome-wide association study, is a departure from the 13-year old genome-wide association model, which has been used to search for common mutations in the DNA of patients of people with the same diseases.

Co-author Joshua Denny, a biomedical informatics researcher at Vanderbilt, says that the newer method can help link seemingly unrelated symptoms, detect potentially harmful side effects of a drug, and help find new uses for drugs.

This is just the tip of the iceberg where translation medicine and EMRs are concerned. Using EMRs to conduct genomic research is becoming an increasingly popular exercise, cutting across a wide range of clinical disciplines.

And it’s not just institutional academic research houses getting into the act. For example, this summer a large northern Virginia hospital announced that it had struck a deal with a Massachusetts analytics firm to see if data mined from EMRs can better predict the risk of preterm live birth.

Now, genomics research is not for just any hospital — it’s obviously a major undertaking — but I think it’s likely more hospitals will get into the game. By this time next year I think there will be a crop of interesting new genomics projects mining EMRs. Although, it will be interesting to see how the 23andMe FDA battle impacts this as well.

Are Patient Portals Really Helping Patients?

Posted on December 4, 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.

One thing’s for sure about patient portals: They’re a hot commodity.

What’s less clear is how much good they’re doing for health care.

The popularity of patient portals stems from Meaningful Use Stage 2 patient-engagement requirements. The market for the products is expected to approach $900 million by 2017, up from $280 million in 2012, according to a report from Mountain View, Calif.-based research firm Frost & Sullivan.

Patients like at least one aspect of the portals — the ability to access their own medical records. In a recent Accenture study, more than 40 percent of consumers who can’t access their own records online said they’d consider switching doctors in order to get access.

But several recent studies suggest that currently available products have a way to go before they can consistently improve care, reduce costs or perhaps even increase patient engagement.

In a review of 46 studies, researchers found little evidence that portals were helping much of anything. The doctors from Veterans Affairs Greater Los Angeles Healthcare System and other institutions wrote that it’s “unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term.”

Some of the limitations of the products, they wrote, included “disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth.” The portals typically gave patients options such as looking at their test results, refilling prescriptions and communicating with doctors.

Patient portals likely are most beneficial, the authors wrote, when they’re part of a more comprehensive quality-improvement strategy.

Another study also found that patients, in many cases, fail to see the value of a portal — or at least some parts of it. In questions about hypothetical features, consumers showed interest in “back-office” tasks such as seeing their own medical records. But clinical digital communication capabilities, such as online video consultations with doctors, failed to impress.

The bottom line was that patient portals “may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.” In other words, most people just don’t seem to be ready to give up face time with their primary-care physician.

When MU2 starts on Jan. 1, physicians will be required to give their patients electronic access to their health records. The requirement went into effect for hospitals in October.

The U.S. health care system is, with government prodding, investing a huge sum in patient portals. The idea sounds empowering for patients. But given the lack of solid evidence for a benefit at this point, it’s concerning to think the money might be better spent on something else. Let’s hope that vendors and providers are soon able to turn portals into something with tangible benefits for quality care.

Epic Builds Lab Installations At Oregon University

Posted on November 27, 2013 I Written By

Anne Zieger 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.

Epic Systems has agreed to build two lab installations of its EpicCare EMR at the Oregon Health & Science University, one to be used for medical informatics education, and the other giving the school access its source code on the research side, reports Healthcare IT News.

Though the school’s OHSU Healthcare system already runs EpicCare for its hospitals and clinics, students and teachers have had to rely on a basic installation of the open-source VistA system for OSHU’s EMR laboratory course.

According to HIN, this is Epic’s first partnership with an academic informatics program, and potentially an important turning point for the company, which has conducted research and development almost exclusively on its Verona, Wis. campus. (It does release its source code to commercial customers.) And the agreement didn’t come easily; In fact, the school spent several years persuading Epic to participate before it agreed to commit to an academic partnership, Healthcare IT News said.

In a press statement, OSHU notes that the EpicCare research environment should allow students to delve into usability, data analytics, simulation, interoperability,  patient safety and more. The school also expects to prepare prototypes of solutions to to real-world healthcare problems.

Students in both OHSU’s on-campus and distance learning programs will pursue coursework based on the Epic EMR, with classes using the live Epic environment beginning March 2014. Work students will undertake include learning to configure screens, implementing clinical decision support and generating reports.

While this isn’t quite the same thing, this agreement brings to mind a blog item by John in which he describes how prospective programmer hires at Elation are required to shadow a physician as part of their hiring process. In both cases, the people who will be working with the software are actually getting an idea of how the product is used in the field before they’re out serving commercial clients. Sadly, that’s still rare.

I think this will ultimately be a win for both Epic and OSHU. Epic will get a fresh set of insights into its product, and students will be prepared for a real world in which Epic plays a major part.

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

Posted on November 18, 2013 I Written By

Anne Zieger 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

Anne Zieger 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

Anne Zieger 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.