Try to get a straight answer on how much an electronic health records system cost for a hospital (yes, I sometimes talk about hospital EMR on this blog too) and it’s nearly impossible. Of course, it’s the number one question on most hospital executives’ minds in light of stimulus funding, a simple price tag is still hard to find and you simply can’t find a straight answer.

Well, the people at MedSphere (memorable for their VW Bus pic at HIMSS) have put out a hospital EHR stimulus ROI calculator. The required fields are provider number and number of beds. As always I’m a bit skeptical about any sort of ROI calculator, but I like to have as much data as possible. So, here’s one other reference for those trying to calculate the EHR stimulus ROI.

The VA announced about 4-5 years ago that they would be releasing their Vista EMR as an open source package. Of course, the headline read “Government Gives Away Free EMR.” In essence, this was true. The government was making their Vista EMR available for free. In fact, I remember one of the people in HIM had an article on this subject and brought it to me when I first started working with EMR software.

I think this was a really smart move by the VA and the government and I think we’re just now starting to see some of the fruits of it being open source come to fruition. Check out this recent post about Vista on EMR and EHR. I have no doubt that the VA’s Vista EMR (err…the open source version of it) will be a player in the hospital EMR space.

The problem I have with it (and feel free to correct me if I’m wrong on this) is that Vista EMR isn’t meant for small practices like solo docs and small group practices in an ambulatory care setting. I’m not saying that it couldn’t be used that way, but it seems to me like taking a sledge hammer to a 1 penny nail. It’s overkill and is likely to cause more problems than good.

Here’s one example of a “feature” I’ve learned about the Vista EMR (and really the MUMPS database that powers it): “VistA is a multi-user system that actually can get faster with more people in the machine.”

I haven’t personally tested the statement, but it makes since why it could be the case. In fact, it’s a really cool feature for a large hospital with a large number of users accessing the same patients over and over again. Now let’s apply this to a small ambulatory practice. You only have a few people accessing a patient. Does this mean that Vista would actually be slower than other databases when you only have a small user base (ie. a small clinical practice)?

I’m not an expert on Vista (and probably never will be), but it seems to me that the marketing message for Vista should have read, “Government Gives Away Free Hospital EMR.”

People have been buzzing over a recent New York Times article (requires login, but you can get a login and password here) which discusses a Harvard study showing little benefit seen so far in Electronic Patient Records. The study is interesting and worthy of consideration. I think this part of the Times article summarizes the findings:

The new study placed hospitals into three groups: those with full-featured electronic health records, those with more basic ones, and those without computerized records. It then looked at their performance on federally approved quality measures in the care of conditions like congestive heart failure and pneumonia, and in surgical infection prevention.

In the heart failure category, for example, the hospitals with advanced electronic records met best-practice standards 87.8 percent of the time; those with basic computer records, 86.7 percent; and those without, 85.9 percent. The differences in other categories were similarly slender.

Reducing the length of hospital stays, according to many experts, should be a big money-saving payoff from electronic health records — as better care aided by technology translates into less time spent in hospitals. For hospitals with full-featured digital records, the average length of stay was 5.5 days; for those with basic computer records, 5.7 days; and those without, 5.7 days.

I’m sorry, but I have a real problem with studies like this. Just think about how many factors play into a hospital’s average length of stay. Would an EMR be on that list? I wouldn’t place it there. At least not anywhere near the top. The same could be said for the heart failure category as well.

I guess my point is that a study of hospitals like this is really hard. There are so many factors involved in the outcomes of a hospital that it is really hard to measure. Plus, no one should kid themselves into thinking that EMR is the end all be all. It is and will solve a number of major challenges, but it’s just one piece of the complex puzzle.

One could also make the argument that hospital EMR software even more than ambulatory care have basically been a substitute for paper processes. Hospitals have the extra money to customize the EMR like crazy so that it basically models the previous paper processes. The real innovation in these hospitals will start to happen now that they’re electronic. Instead of focusing on becoming electronic, they can now focus on optimizing their processes using technology.

Ambulatory practices are often faced with a reasonable amount of change when implementing an EMR since they don’t have the money or the clout to get the EMR customized. For those practices that select a well designed EMR this ends up providing a great ROI for the practice’s investment in EMR. Sadly, this is also likely the reason that the EMR implementation failure rate is so high. When done right, it’s a great experience with a great return for the practice. When done wrong it’s a disaster.

If you’ve read this blog for any length of time. You know a couple things that I rarely ever do. One is talk about hospital EMR systems (I prefer ambulatory EMR). The other is endorse specific EMR vendors (too many individualized factors). I’m not really going to do either of them here in this post either. However, it might sound like it, so I don’t want people to be confused;-)

A few weeks ago, I went to the HIMSS Hittin’ the Streets even in Las Vegas. I’ll admit that my driving motivation for attending the event was to be able to hear Marc Probst speak about EMR and ARRA. Since I inundated you with posts from that talk by Marc Probst, you can safely assume that attending was a great decision.

As part of my agreement to attend the event for free, I agreed to attend at least one of the vendor demonstrations. Looking at the schedule I decided to attend the Sapphire EMR presentation. I knew pretty much nothing about Sapphire before I went to the presentation. After the event I tried to find their website and it took me a while to figure out that the company’s name was IntraNexus.

I’ll admit that I was a little disappointed to find out that Sapphire was an EMR designed for hospitals. I would have rather seen a presentation of an ambulatory EMR. However, I’d committed to be there and so I stayed and listened to what they had to say. Plus, there’s a ton of cross over between hospital EMR software and ambulatory EMR software.

I’ll admit to being pleasantly surprised by Sapphire’s presentation and approach to building a hospital EMR. I’ve heard so many horror stories about hospital EMR softare (you know the list of software I’m talking about), but I really liked what I heard about Sapphire.

Some examples of things that I found interesting: their approach to customer service, how they handled audit tracking for HIPAA, sharing of work between various users of their system, clinical process review before implementation, etc. I can’t remember them all. Of course, I only saw a 1-2 hour presentation of what they were about, but I’ll admit that I went away impressed with what they’d done and the people behind the product. Trusting the EMR vendor you’re working with is a huge thing for me and in my short time with them, Sapphire showed a lot of promise.

I will admit that they had one MAJOR flaw in their presentation. When they finally started to demo part of the software, the application was extremely slow. They of course, blamed it on the hotel wireless. Could be true, but it left a nice black mark on what was an otherwise nice presentation. Of course, there’s a lot of factors in speed, but if you’re going to tout access to your EMR software from all sorts of devices like cell phones then it better be relatively speedy on those devices. In fact, I raised the issue of slowness and the CEO, Rick O’Pry, commented that the application would probably have been faster on his iPhone. I’m sure he was right.

I’m guessing that Sapphire will be disappointed to know that HIMSS sent me to their demo when I have little interest in a hospital EMR solution. At least they get a nice blog post covering their company. Although, this post would have been more fun for me had it been a really dysfunctional hospital EMR presentation.

As you know, I try to save my simpler posts for the weekend when less people are reading. Although, I do tend to ramble on occasion. Thankfully I type reasonably fast.

In some of my EMR readings of late I came across something that sounds similar to what I’ve talked about doing for EMR. They call it an EMR Buying Seminar. Sure, there have been a ton of EMR seminars lately. In fact, I did an EMR presentation in Austin myself. However, what struck me about this seminar is that it said it was the 10th annual EMR Buying Seminar. That’s a lot of years.

Of course, the thing I like least about this seminar is that it’s focused on hospital EMR systems. If you’ve read here much, you know I’m more of an ambulatory EMR kind of guy. Certainly there’s a lot of cross over, but the hospital stuff is far too political for my tastes.

I wonder how many people would be interested in an Ambulatory EMR Buying Seminar. Seems like it could be a really valuable thing including covering the details of the ARRA EMR stimulus package. I know the perfect place to hold it as well: Las Vegas. Let me know what you think of the idea.

Of course, an EMR Buying Seminar is a great thing for doctors and practice managers. My other idea I’m considering is holding an EMR conference of experts in EMR from the industry. Kind of a meeting with a wide open agenda and format where the participants are the presentation and become the conference. Basically, a bunch of really smart people getting together to discuss complex issues related to EMR. Could be a lot of fun.

How’s that for a short post that’s not so short?

Healthcare data sharing is one of the hottest topics when talking about the importance of EMR software. Some people call it healthcare data portability. One of the problems I have with these discussions is that everyone has different goals for why they want to share the information. Here’s a partial list of reasons people may want to share healthcare data between various EMR respositories (in no particular order):

• Clinical data sharing for reimbursement purposes
• Quality data sharing for broader research goals
• Quality data sharing to meet ARRA requirements/reimbursement
• Data shared for continuity of care between providers

There are probably other reasons to have EMR software be able to share clinical data. However, you get the basic point. There are a lot of reasons why people want the ability to share healthcare related data from an EMR. One problem in the discussion of EMR data portability is that the conversation often gets convoluted when clear lines aren’t drawn for why the EMR data is being shared. Kind of reminds me of what it’s like to discuss EMR and not differentiate between a hospital EMR and ambulatory EMR. There are important similarities, but there are also important differences which always seem to confuse the discussion.

This weekend I had the delightful experience of spending time hanging out in the hospital as my wife gave birth to our third child. All went well and baby and Mamma are doing well. Of course, having this fanatical EMR background that I do, I couldn’t help bet spend many moments considering on the impact of an EMR at the hospital. Certainly I was watching as the nurses spent a lot of their time at the computer entering in all sorts of granular data about what was happening in our room. It was interesting to watch how laborious it was for them to enter everything. I could see many of them dreading that part of the job.

However, the thing that hit me most was that the computer was so rarely in the middle of my wife and baby’s care. At all of the most important points the computer wasn’t even really present. Other sophisticated technical devices were there, but the computer and the EMR were no where to be seen. No EMR when they measured her contractions. No EMR when they gave her a spinal tap (don’t ask me the real technical terms). No EMR when the doctor was performing the c-section. The first time I saw an EMR was actually when we took my new born baby into another room to do all the necessary weighing, immunizations, etc.

Now the question I asked myself was if I felt like I was getting any worse care because the EMR wasn’t at the center of our care? The answer of course is no. Was the EMR probably running somewhere in the background? For most of the care, yes. However, it didn’t really matter to us, because we knew we were in the hands of professionals who were going to do the best job they could do.

Now I’ve always felt like I was a strong doctors advocate (those who’ve read me for a while can agree or disagree), but I must admit that this experience really highlighted the importance of the doctor’s skills in the level of care that’s given. No EMR can replace that. I also find it interesting that doctors are required to provide such detail when they do a procedure they’ve done a hundred times. Imagine if we required our IT people to detail every time they installed a new printer.

Sorry for a few personal musings of a tired new father. Just remember that an EMR won’t be there for me at 4 AM when the babies crying either. However, EMR and HIPAA will be, and I’ll be typing away.