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Are CIOs Done with the Plumbing and Ready for the Drywall?

Posted on December 4, 2015 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.

At RSNA 2015 I had a chance to sit down with Evren Eryurek, Software Chief Technology Officer at GE Healthcare. We had a wide ranging conversation about what’s happening across all of healthcare IT and GE’s new healthcare cloud offering. However, the thing that stuck with me the most from our conversation was the comment he used to open our conversation.

Evren told me that as he sits down with health care CIO’s he’s finding that CIO’s are done with the plumbing work and now they’re asking the question, “What’s next?”

This statement really resonated with me. Up until now we’ve been doing a lot of the plumbing work in healthcare. It’s necessary work, but it’s stuck behind the walls and most people take it for granted really quickly. We see that first hand with EHR software and all the interfaces to the EHR software. We absolutely take for granted that charts are instantly at our fingertips with the click of a button. We take for granted that charts are legible. I could go on, but you get the point.

The problem is that even though we have the plumbing work done it’s still pretty ugly. We haven’t put up the drywall (to continue the metaphor) that will add some real form and function to the plumbing and framing work (the EHR) that we’ve been doing the past couple years. I think organizations are ready for this now.

While at RSNA I also spent some time talking with Rasu Shrestha, MD, MBA, and Chief Innovation Officer at UPMC. I asked him what topic was most interesting to him. His answer was “Data Tranformation.” I plan to have a future video interview (see our full history of video interviews) with him on the subject.

His concept of data transformation aligns really well with what other CIOs were telling Evren. They’re ready to figure out what we can do with all of this EHR data to improve care and move health care forward. The plumbing work is done. The foundation is laid. Now let’s look to the future of what we can do.

This same sentiment is reflected in a comment John Halamka, MD, MS, and CIO at Beth Israel Deaconess Medical Center, made in a recent blog post, “our agenda is filled with new ideas and it feels as if the weights around our ankles (ICD10, MU) are finally coming off.”

Increasing Nursing Satisfaction through Technology Helps Improve Patient Care

Posted on October 29, 2015 I Written By

The following is a guest blog post by Karlene Kerfoot, Chief Nursing Officer at API Healthcare.
Karlene Kerfoot - API Healthcare - GE Healthcare
Technology is an undeniable force in the healthcare industry and plays a daily role in a nurse’s life. Nurses are responsible for managing devices and utilizing the electronic health records, among many other things. Whenever patient care requires a nurse, they will interact with advanced technologies. As a result, improving these digital systems to better improve clinicians’ ability to provide care is at the top of mind for most hospitals.

While hospitals and health systems work to implement and improve technologies, it is important to keep in mind how that technology can have larger implications. One consideration is how the innovation impacts your work staff’s satisfaction.

Nurses are the heart of the healthcare team and are the most patient-facing representatives. Research has shown that changes in technology, among other things, may allow for substantial improvements in the use of nurses’ time and the delivery of safe patient care. However, technology that isn’t nurse-friendly can impede the work of the nurse. When hospitals find ways to streamline processes and make things more convenient for nurses to do their jobs, it can lead to increased job satisfaction. Furthermore, nurses who feel empowered in their roles are more effective and report better patient care, which is one of the ultimate goals hospitals set for success.

In addition to how technology helps nurses during their day-to-day jobs, hospitals can also use technology to manage broader job satisfaction when it comes to things like staffing and scheduling. Nurses often face a unique set of challenges when it comes to their schedules, workflow and even things like career development – all of which requires hospitals to rethink how they enable work satisfaction through technology.

For example, because patient needs can be unpredictable, it is often times challenging for hospitals to predict their staffing needs on an hourly or daily basis, especially during spikes around the holidays that pull nurses away from families and personal needs.

If a nurse is consistently working overtime hours, situations like handling too many patients or being assigned to patients outside of their training/expertise can inhibit their ability to advance their careers. In addition, fatigue and stress as a result of nurses working extensive periods of overtime can result in serious and potentially life-threatening medical errors. In fact, the odds of making an error are more than three times higher when nurses work shifts of 13 hours or more.

Newer workforce technology systems for nurses can help to ensure a fair and equitable workload so managers can set up their staff for success, and make changes to schedules by pairing up staffing needs to things like patient acuity or census numbers by the day or hour. These technologies also give nurses the opportunity to take more control over their schedules and avoid the burnout.

The ability to use tools that help with staffing needs supports additional research that shows that nurses who work excessive amounts of overtime, produce lower quality work and their happiness levels decrease, which ultimately impacts the patient satisfaction and hospital’s bottom line.

The value technology has brought to healthcare is growing by leaps and bounds, but at the core of healthcare are the patients and the people who can help them. Technology has infinite ability to help both, and it is important that health systems have access to resources that allow them to make better staffing decisions.

About Dr. Karlene Kerfoot
Dr. Karlene Kerfoot is the Chief Nursing Officer for API Healthcare, a GE Healthcare Company. API Healthcare is a leader in healthcare workforce optimization technology and service. Dr. Kerfoot is widely acknowledged for her work in patient safety, data-driven staffing and scheduling, creating healing environments and healing sanctuaries for staff, pioneering models of shared governance, and achieving excellence in quality outcomes.

EMR Market Share

Posted on July 18, 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.

Editor’s Note: This is the first post on EMR and HIPAA by James Ritchie. James is a longtime journalist including the past eight years as a staff writer with the Cincinnati Business Courier.

Practice Fusion announced in June that it led the EMR industry in market-share gains.

Citing SK&A reports, the San Francisco-based firm boasted that it controlled 5.8 percent of the market as of May, up from 3.8 percent in July 2012. Beyond Practice Fusion, only Epic, AthenaHealth and Cerner showed gains.

In this data, which represents physician offices only, Allscripts was the market leader, with a 10.6 percent share. Not far behind were eClinicalWorks, with a 10.5 percent share, and Epic, with 10.3 percent. (The report that Practice Fusion links to is actually dated January 2013.)

But there’s more than one way to look at the EMR share picture.

Epic was the clear winner in a report by the Austin, Texas-based consultancy Software Advice on meaningful use attestations. Epic, based in Verona, Wis., accounted for 20.3 percent of attestations for a complete EHR in an ambulatory setting.

The firm’s competitors were nowhere close as of the March 2013 report. Allscripts was the system of choice for 11.6 percent of attestations by eligible professionals, and eClinicalWorks accounted for 8 percent. Next on the list were NextGen Healthcare, GE Healthcare and, with 2.7 percent share, Practice Fusion.

Software Advice claimed that the figures, based on Centers for Medicare and Medicaid Services data, might be the best around. They at least provide a standard in a market where vendors “use varied criteria to calculate their customer base,” according to the company.

Companies “might count number of users (which could include everyone from physicians to administrative staff), number of medical providers (which could include everyone from physicians to midwives) or number of practices,” Software Advice noted on its website.

Practice Fusion, founded in 2005, claimed in its press release to have doubled both its monthly active user base of medical professionals and its patient population between 2012 and 2013. The company claims to reach “a community of 150,000 medical professionals serving 65 million patients.”

The prospects for the free model that Practice Fusion uses are still up in the air. Doctors might question whether they want ads, unobtrusive as they are at the bottom of the screen, to compete for their attention when they’re entering patient data. Data, by the way, might prove to be the real revenue generator for Practice Fusion. In June the firm launched Insight, an analytics product offering a population-level view of diagnoses, prescribing patterns and other information. It’s a model worth watching. If Facebook and google can build businesses on data, maybe Practice Fusion can, too.

The SK&A figures show just how fragmented the outpatient EMR/EHR market is. The top 10 vendors accounted for only 64.8 percent of attestations, leaving about 35 percent of the market to the “other” category. By Software Advice’s count, 560 firms logged at least one meaningful use attestation.

Eager to steal share are firms like Irvine, Calif.-based Kareo Inc. It launched its own free, cloud-based EHR in February based on technology acquired from San Mateo, Calif.-based Epocrates Inc. The firm reported in June that 4,000 providers had signed on, with a third of them moving from another EHR.

Of course, ambulatory adoption is only part of the EMR story.

Epic is No. 1 among the nearly 3,000 hospitals that have received federal incentives for using complete electronic records systems, according to Modern Healthcare. The company holds a 19.6 percent share, followed by Computer Programs and Systems Inc. with 15.5 percent, Meditech with 14.1 percent and Cerner with 11 percent. The late-May report was based on numbers from CMS and the Office of the National Coordinator for Health Information Technology.

The inpatient market is far less fragmented than the outpatient space. The top 10 companies control 92 percent of share, according to the report.

No matter how you count share, the EMR space will continue to be hypercompetitive because of the dollars at stake. The market amounted to $20.7 billion in 2012, up 15 percent from 2011, according to the research firm Kalorama Information.

Health IT & EMR Advertising

Posted on September 5, 2012 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 want to take a minute to say a big Thank You to all the advertisers that support EMR and HIPAA. If you enjoy the content on EMR and HIPAA, then take a minute to look through this list and get an idea of the companies that support what we do.

The following are the new advertisers since I last posted about EMR and HIPAA advertisers, and then the list of renewing advertisers.

New Advertisers
Digital Health Conference – I wrote previously about how much I like the Digital Health Conference in New York City. So, you can imagine I’m happy to have their event advertised on EMR and HIPAA. I hope that I see many of you at the event. It’s a great one and seems to have even gotten better this year.

GE Healthcare – If any of you watched the Olympics, you have certainly seen that GE is doing a lot of work in healthcare. It is kind of cool to think that GE healthcare is advertising in the Olympics and on EMR and HIPAA. Obviously, quite a bit different goals and EMR & HIPAA might be a little more targeted to healthcare IT professionals than the Olympics.

Physia – For those of you who haven’t yet seen me talk about Physia on Twitter, this is a new venture I’m doing with Shahid Shah. Physia does really low cost physician websites. However, that’s just the beginning of what we have in mind. We plan to layer a whole set of services on top of those websites that turn your website from a glorified yellow page ad into an integral part of your office. It’s an exciting project that is going to bring physician websites into the next century.

Renewing Advertisers
Practice Fusion – Advertising since April 2010
SOAPware – Advertising since July 2010
EMR Consultant – Advertising since July 2009
Ambir – Advertising since January 2010
Amazing Charts – Advertising since May 2010
DrFirst – Advertising since January 2012
GE Centricity Business – Advertising since May 2011

I’m very appreciative of those advertisers who support the work we do. As I look at the stats for the advertisers, I’m really happy that we’re providing real value to their company.

Meaningful Use Stage 2 Standards Video – Meaningful Use Monday

Posted on April 2, 2012 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.

Self proclaimed Standards Geek for GE Healthcare, Keith Boone, did a good presentation covering the meaningful use stage 2 standards along with briefly covering the meaningful use stage 1 standards and looking at the standards we might see beyond meaningful use stage 2. This meaningful use stage 2 standards presentation was done at the Crossing the Infrastructure and HITECH Meaningful Use Divide conference.

If you’re into healthcare standards, then you’ll enjoy this video. If you get confused or just don’t care about the various alphabet soup standards, then you won’t find this video that interesting or likely useful.

I think this video also illustrates a couple important points. First, healthcare standards are pretty complex. Second, a lot of thought and effort has been put towards these standards. Thanks to meaningful use and the EHR incentive money, EHR vendors don’t really have too much choice on whether to adopt these standards or not any more. Although, as Keith point out, these are just proposed standards. The meaningful use stage 2 feedback period is still open, so I encourage you to provide your comments during this period. ONC does listen to this feedback and do its best to incorporate it in the final rule.

As a side note, if you like EHR and Health IT videos, be sure to check out this EMR & EHR Video website. We just passed the 200th video posted on that site. Plus, I just did some math using our analytics programs and we’ve had about 432 hours of video watched on that site this year.

GE Centricity Advance Ceasing Operations

Posted on January 26, 2012 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.

Yesterday I had the opportunity to talk with the people from GE who briefed me that GE is in the process of shutting down their GE Centricity Advance product line. This was pretty big news to me since I remember just last year at HIMSS meeting with GE and hearing that for the small practice (I believe 1-10 docs) GE Centricity Advance was where they were putting all their effort. You could see the energy they had behind it. In fact, their iPad EHR app was built on top of the GE Centricity Advance solution (which is now being moved to their other EHR product lines).

You might remember that the GE Centricity Advance solution was actually created out of the purchase of MedPlexus in March 2010. At the time, MedPlexus had 100 employees out of California with the development team out of India. At the time of purchase it seemed GE’s acquisition would provide a SaaS based EHR option to the independent physician market. Plus, MedPlexus (which became GE Centricity Advance) also provided an integrated Practice Management System with the EHR.

The GE Centricity Advance website is already forwarding to the Centricity Practice Solution website and a letter was sent out to all Centricity Advance customers informing them that the product line was ceasing operation. I’ve asked for a copy of that letter and if I get it, I’ll add it to this post (or if you’re a customer that received it and doesn’t mind sharing we’d welcome it).

I was told that GE is offering Centricty Advance users a free transfer to their Centricity Practice Solution EHR software. From what they told me it seems this will include data migration, training on the new system and a license for Centricity Practice Solution. Of course, Centricity Advance was paid on a subscription model so they’ll have to continue paying the monthly fee. As with most data migrations, I don’t think we’ll know how good GE is at migrating the data from GE Centricity Advance to Centricity Practice Solution until they start to do them.

Since both Centricity Advance and Centricity Practice Solution have ONC-ATCB complete EHR certification, there shouldn’t be any problems for those that transfer to Centricity Practice Solution when it comes to EHR stimulus money. Those not wanting to move to the Centricity Practice Solution will have this as part of their decision on what to do once Centricity Advance is no longer supported. I expect there will be many in this situation since while Centricity Practice Solution is available through GE’s partners as a “SaaS” offering, I think many will want to find a true from the ground up web based SaaS EHR offering.

I asked how many providers would be effected by the end of the Centricity Advance product line, but it’s GE’s policy to not comment on those numbers.

Where does this leave GE Centricity EMR software?
GE Healthcare IT still does a couple billion dollars of business and still has three EMR software offerings:
*Centricity Practice Solution – The replacement for Centricity Advance and will be GE’s EMR offering for the 1-100 provider practices.
*Centricity EMR – Still ambulatory EMR, but for the 100+ provider practices.
*Centricity Enterprise – Acute care EMR

I’m sure that many will wonder how good the Centricity Practice Solution will do in the small practice arena. Will this basically mean that GE is no longer a player in the small 1-10 provider practices? It’s hard to say for sure, but I’ll be interested to see how the Centricity Practice Solution EHR does in this market. There must have been a reason they purchased what became Centricity Advance instead of going with Centricity Practice Solution in the first place.

On the other hand, I could see people making the argument that this is a sound strategy by GE since movements like accountable care organizations (ACO’s) and related initiatives are putting the small practice in jeopardy. We know that many hospital systems are purchasing up group practices as they prepare to become an ACO among other reasons. While we still have many small group practices, it’s worth considering how many of them will survive the changing landscape. If not many survive, then this strategy by GE could end well for them. Although, I personally believe that practice consolidation is cyclical and so I’m not ready to announce the death of small group practices yet.

Another trend that might make this a good decision on GE’s part is what I call the Smart EHR. Our current phase of EHR adoption is basically converting paper to electronic. Once doctors start requiring EHR software to do things far more advanced (see Artificial Intelligence and Genomics EHR), it will require a new kind of EHR. Maybe Centricity Advance wasn’t prepared to make this shift. We’ll see if GE’s other EHR software is ready for it.

Many have argued that EHR consolidation is inevitable. I guess I shouldn’t be surprised that part of that EHR consolidation is happening within the same EHR company. I’m sure there are more on the way as we see which EHR companies survive the meaningful use winter and come out on the other side and which EHR companies close up shop.

Update: I asked GE for some more clarification on when GE Centricity Advance would be sunset and which data they’ll be migrating as part of the data migration process. Here are their answers:
Sunset Period: We have announced that we will cease operations of Centricity Advance on June 30, 2012. The data will be available in read-only mode until December 31, 2012.

Data Migration: We are working with our partners and customers to figure out the best way to migrate data. We have told customers that we will migrate the following data:
a. Patient Demographics, Patient Insurance data, Fee Schedules, Appointments
b. Patient Summary
c. Patient chart
We will migrate all clinical data. We are working with our partners to determine which financial information should be automatically migrated.

Top Considerations for Transitioning to ICD-10 – Guest Post

Posted on August 30, 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.

Chuck Podesta is Fletcher Allen Health Care’s chief information officer.

ICD-10 would not be so daunting if the deadline was not occurring during the rush to get EHRs for meaningful use. Add in value-based purchasing, bundled payments and transitioning to ACOs, and you can see why many CIOs are retiring early or migrating to the vendor or consulting world. We are just over two years away from the October 2013 deadline, and there is much work to be done. ICD-10 contains 68,000 codes, as opposed to the 13,000 currently used in the ICD-9 world. There is a code for every condition that exists on the planet.

The revenue cycle system, which includes registration, HIM and billing/AR, will be the lynch pin to ICD-10 readiness. Having a solid vendor partner and a strong product is key to a successful transition. Many solution providers – like GE Healthcare, who recently launched the 5.0 version of their Centricity Business product – are updating their systems to better comply with ICD-10. GE Healthcare also allows existing Centricity Business customers to retrofit the new ICD-10 functions to the 4.6 version of the product. Strong vendor partners take the burden off you by being ahead of the game and delivering the appropriate technology in time so you are not racing to the finish line.

By now, you should have at least a steering committee in place. Your IT shop should have completed an inventory of all applications that are impacted by ICD-10, including reporting systems. You will be surprised by the number of applications, even if you have taken the one-vendor approach for most of your IT needs. You will need to contact all affected application vendors to see what the plans are for ICD-10 compliance. Most likely, upgrades will be required that will need to be scheduled.

Training of coders will be critical, along with implementing clinical documentation improvement programs. Documentation improvement programs are difficult to implement and will be viewed by providers as more work on top of an already busy schedule. New technologies such as computer-assisted coding will definitely help, but success will be a combination of process improvements and technology.

Lastly, remember that the deadline is for Medicare and Medicaid patients only. Unless the rest of the payer industry follows the same deadline (highly unlikely), you will need to run both ICD-9 and ICD-10 systems.

Healthcare IT an Important Component of New ACO Program

Posted on April 5, 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.

John’s Note: The following is a guest post by Mark Segal talking about the recently announced ACO program and it’s relationship to EHR, meaningful use, and healthcare IT. I also love the insider look at rule making.

The long-awaited proposed rule on Medicare’s Shared Savings Program (SSP)/Accountable Care Organization (ACO) program is out. These 429 pages outline how the Administration plans to transform U.S. health care delivery from fee-for-service to a value-based emphasis on accountability for quality and efficiency of care provided for populations. Following a final rule later this year, the program is to start January 1, 2012, with additional January 1 annual starts by ACOs, and a special optional start possible for July 1, 2012 given the tight timing this year.

CMS solicits comments on program design areas. The final rule will certainly track the proposed rule in key aspects, but there could be important changes based on comments – although revisions must be within the scope of proposed rule options because CMS cannot add new concepts in the final rule.

Care coordination, patient centeredness and evidence-based medicine are major priorities. As expected, therefore, health information technology (HIT) and electronic health records (EHRs) will be central to ACO success.  In some cases, HIT is cited explicitly; for example at least 50 percent of ACO primary care physicians must be meaningful users of EHRs in an ACO’s second year.

In other cases, CMS, focusing on patient engagement, care coordination, and care transitions, highlights HIT capabilities an ACO should address in its SSP application. For example, CMS calls out using EHRs and health information exchange (HIE) to send care summaries at care transitions.  In addition, CMS flags HIT areas like telehealth and remote monitoring, evidence-based medicine, and measuring physician performance across practices and using measurements to improve care and service. Also, HIT will be central to the need to report on and achieve desired levels (after year one) of many of the 65 quality measures.  For example, HIT could help reduce levels of healthcare-acquired conditions.

CMS’s HIT approach is non-prescriptive.  An ACO must address, in its application, how it would address such requirements as care coordination (including use of HIT) but CMS does not dictate technology tools or specific features.   Fundamentally, CMS is outcomes-focused, looking at up-front plans and then focusing on ACO ability to meet quality metrics and overall efficiency goals.  Such flexibility contrasts with meaningful use, which is highly prescriptive.  ACOs will have flexibility to design and deploy their HIT strategies.  Overall, such flexibility should also be considered as the HIT Policy Committee, ONC and CMS consider requirements for Stage 2 of meaningful use, especially for newer areas of HIT use.

Finally, of concern, and relevant also to the need for multi-year meaningful use roadmaps, CMS reserves the right to annually change the SSP during three-year ACO agreements.  Although CMS excludes some areas from such annual changes, this uncertainty is worrisome given the substantial investments and organizational changes that must be made by ACOs.  Three years is a blink of the eye in care transformation; ACOs need regulatory stability and predictability to plan and invest with confidence and to succeed at the change management that will underlie ACO success.

So read carefully and submit timely comments!

Mark Segal is the vice president of government and industry affairs at GE Healthcare IT.