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!!

Public Health Agencies Struggle To Integrate With HIEs

Posted on September 21, 2017 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.

New research by ONC suggests that while public health agencies might benefit from connecting with HIEs, there are still some significant barriers many need to address before doing so.

Public health agencies at both the state and local level collect information from providers as part of conducting disease surveillance activities and maintaining data registries. Though some of these registries are common – notably those focusing on childhood immunizations, birth defects and cancer—the agencies’ technical infrastructure and data formats still vary. This makes sharing data between them difficult.

One alternative to cumbersome data matching between agencies is for the agencies to integrate with an HIE. According to the ONC report, public health researchers have begun to find that at least some of the time, the data they get from HIE organizations is richer than data from clinical systems. Not only that, when public health agencies integrate their information systems with HIEs, it can help them conduct many of their functions more effectively. However, it’s still unusual to find HIE-connected agencies as of yet.

In its new report, ONC outlines what it learned about what the agencies hoped to accomplish with HIE integration and how they moved ahead with integration. To find this out, ONC contracted with Clinovations Government + Health, which participated in discussions with eight entities and analyzing more detailed information on 10 others.

Virtually all respondents had two goals for HIE integration: 1) Minimizing the number of connections needed to link providers, HIEs and agencies and 2) Helping providers meet public health requirements for Medicare and Medicaid EHR incentive programs. A small subset also said that over the longer term, they wanted to create a sustainable platform for clinical and public health exchange which could support enhanced analytics and quality measurement.

Not surprisingly, though, they face considerable challenges in making HIE integration actually happen. In most cases, technology issues were possibly the toughest nut to crack, and almost certainly the most complex. To connect with an HIE, agencies may confront incompatible transport and messaging protocols, standards problems, data classification and coding issues, inconsistent data quality, and their often-inflexible legacy systems, to name just a few of the many problems ONC cites.

As if that weren’t enough, the agencies may not have the funding in place to take on the integration effort, and/or lack a stable funding stream; don’t have the kind of cross-functional leaders in place needed to integrate their systems with HIEs; grapple with complicated patient data privacy and security issues; and bump up against state laws limiting data sharing methods.

However, through its research, the ONC did gather some useful feedback on how the agencies were coping with the long list of HIE integration challenges they face. For example, to win over the support of policymakers, some agencies have emphasized that they’ll be able to use HIE data for higher-level analytics and quality measures. The respondents also noted that HIE integration got more internal support when they got buy-in from top leaders and second-tier leaders have project management, technical and policy skills.

Given these odds, it’s little wonder that the number of public health agencies successfully integrating with HIEs is still small. That being said, there’s good reason for them to keep pushing for integration, so their number is likely to grow over the next few years.

Will Medical Device Makers Get Interoperability Done?

Posted on September 20, 2017 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.

Most of the time, when I think about interoperability, I visualize communication between various database-driven applications, such as EMRs, laboratory information systems and claims records. The truth is, however, that this is a rather narrow definition of interoperability. It’s time we take medical device data into account, the FDA reminds us.

In early September, the FDA released its final guidance on how healthcare organizations can share data between medical devices and other information systems. In the guidance, the agency asserts that the time has come to foster data sharing between medical devices, as well as data exchange between devices and information systems like the ones I’ve listed above.

Specifically, the agency is offering guidelines to medical device manufacturers, recommending that they:

  • Design devices with interoperability in mind
  • Conduct appropriate verification, validation and risk management to ensure interoperability
  • Make sure users clearly understand the device’s relevant functional, performance and interface characteristics

Though these recommendations are interesting, I don’t have much context on their importance. Luckily, Bakul Patel has come to the rescue. Patel, who is associate director for digital health the FDA‘s Center for Devices and Radiological Health, offered more background on medical device interoperability in a recent blog entry.

As the article points out, the stakes here are high. “Errors and inadequate interoperability, such as differences in units of measure (e.g., pounds vs. kilograms) can occur in devices connected to a data exchange system,” Patel writes. Put another way, in non-agency-speak, incompatibilities between devices and information systems can hurt or even kill patients.

Unfortunately, device-makers seem to be doing their own thing when it comes to data sharing. While some consensus standards exist to support interoperability, specifying things like data formats and interoperability architecture design, manufacturers aren’t obligated to choose any particular standard, Patel notes.

Honestly, the idea of varied medical devices using multiple data formats sounds alarming to me. But Patel seems comfortable with the idea. He contends that if device manufacturers explain carefully how the standards work and what the interface requires, all will be well.

All told, If I’m understanding all this correctly, the FDA is fairly optimistic that the healthcare industry can network medical devices on the IoT with traditional information systems.

I’m glad that the agency believes we can work this out, but I’d argue that such optimism may be premature. Patel’s assurances raise a bunch of questions for me, including:

  • Do we really need another set of competing data exchange standards to resolve, this time for medical device interoperability?
  • If so, how do we lend the consensus medical device standards with consensus information system standards?
  • Do we need to insist that manufacturers provide more-consistent software upgrades for the devices before interoperability efforts make sense?

Hey, I’m sure medical device manufacturers want to make device-to-device and device-to-database data sharing as simple and efficient as possible. That’s what their customers want, after all.

Unfortunately, though, the industry doesn’t have a great track record even for maintaining their devices’ operating systems or patching industrial-grade security holes. Designing devices that handle interoperability skillfully may be possible, but will device-makers step up and get it done anytime soon?

Searching EMR For Risk-Related Words Can Improve Care Coordination

Posted on September 18, 2017 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.

Though healthcare organizations are working on the problem, they’re still not as good at care coordination as they should be. It’s already an issue and will only get worse under value-based care schemes, in which the ability to coordinate care effectively could be a critical issue for providers.

Admittedly, there’s no easy way to solve care coordination problems, but new research suggests that basic health IT tools might be able to help. The researchers found that digging out important words from EMRs can help providers target patients needing extra care management and coordination.

The article, which appears in JMIR Medical Informatics, notes that most care coordination programs have a blind spot when it comes to identifying cases demanding extra coordination. “Care coordination programs have traditionally focused on medically complex patients, identifying patients that qualify by analyzing formatted clinical data and claims data,” the authors wrote. “However, not all clinically relevant data reside in claims and formatted data.”

For example, they say, relying on formatted records may cause providers to miss psychosocial risk factors such as social determinants of health, mental health disorder, and substance abuse disorders. “[This data is] less amenable to rapid and systematic data analyses, as these data are often not collected or stored as formatted data,” the authors note.

To address this issue, the researchers set out to identify psychosocial risk factors buried within a patient’s EHR using word recognition software. They used a tool known as the Queriable Patient Inference Dossier (QPID) to scan EHRs for terms describing high-risk conditions in patients already in care coordination programs.

After going through the review process, the researchers found 22 EHR-available search terms related to psychosocial high-risk status. When they were able to find nine or more of these terms in the patient’s EHR, it predicted that a patient would meet criteria for participation in a care coordination program. Presumably, this approach allowed care managers and clinicians to find patients who hadn’t been identified by existing care coordination outreach efforts.

I think this article is valuable, as it outlines a way to improve care coordination programs without leaping over tall buildings. Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence, and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Still, it’s good to know that you can get meaningful information from EHRs using a comparatively simple tool. In this case, parsing patient medical records for a couple dozen keywords helped the authors find patients that might have otherwise been missed. This can only be good news.

Yes, there’s no doubt we’ll keep on pushing the limits of predictive analytics, healthcare AI, machine learning and other techniques for taming wild databases. In the meantime, it’s good to know that we can make incremental progress in improving care using simpler tools.

Willingness To Invest In Outpatient EHRs and PM Solutions Grows

Posted on September 15, 2017 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 the ambulatory EHR market remains somewhat stable, the number of organizations preparing to get out of their existing system has climbed over previous years, along with an increase in the number of organizations prepared to upgrade their practice management solution, according to new data from HIMSS.

To conduct the 9th Annual Outpatient PM & EHR Study, HIMSS Analytics reached out to physicians, practice managers/administrators, practice CEOs/presidents, PAs, NPs and practice IT directors/staff. A total of 436 professionals responded to its web-based survey.

The survey concluded that 93% of hospital-owned outpatient facilities had a live, in-operation EMR in place. Meanwhile, 70% of respondents representing free-standing outpatient facilities said they had an EHR in place, down from 78% last year.

As part of its survey, HIMSS Analytics asked respondents whether they planned to purchase an entirely new ambulatory EHR system, replace the existing system upgrade the system within the next two years.

The responses suggest that there’s been some new movement in the ambulatory EHR market. Most notably, 10.6% of respondents said they plan to replace their current solution, up from 6.4% in 2014. This is arguably a significant change. Also, 23.8% respondents said they were upgrading their current ambulatory solution, up from 20.8% in 2014.

In addition, the number of respondents with no investment plans fell below 60% for the first time in four years, HIMSS Analytics noted.

Though the practice management system market seems to be a bit more stable, some churn appears to be emerging here as well. Eleven percent of respondents said they plan to upgrade their current PM solution, down from 20.8% in 2014, and 9.3% said they plan to replace their current system, up from 6.4% in 2014.

All in all, there’s not a great deal of replacement activity underway, though the data does suggest a small spike. That being said, I was interested to note that respondents’ willingness to invest in a new system was higher than their willingness to upgrade a system they have.

The question is, why would ambulatory providers be ready to junk their existing EHR and practice management solutions now as opposed to three years ago? Are we reaching the end of a grand health IT replacement cycle or is there more going on here?

One possibility is that with MACRA kicking in, outpatient providers have been forced to reevaluate their existing systems in terms of their ability to support participation in QPP. Another fairly obvious possibility is that ambulatory providers are choosing to systems they feel can support their movement into value-based care.

From what I can tell, providers choosing new systems for these reasons are actually a bit behind the curve, but not terribly so. When their peers attempt to push forward with their three, four or even five-year-old systems, then you may see a replacement frenzy. Sometimes you just can’t afford to stick with Old Faithful.

Health IT Group Raises Good Questions About “Information Blocking”

Posted on September 8, 2017 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.

The 21st Century Cures Act covers a great deal of territory, with provisions that dedicate billions to NIH funding, Alzheimer’s research, FDA operations and the war on opioid addiction. It also contains a section prohibiting “information blocking.”

One section of the law lists attempts to define information blocking, and lists some of the key ways healthcare players drag their feet when it comes to data sharing. The thing is, some industry organizations feel that these provisions raise more questions than they answer.

In an effort to nail things down, a trade organization calling itself Health IT Now has written to the HHS Office of Inspector General and ONC head Donald Rucker, MD, asking them to issue a proposed rule answering their questions.  Parties signing the letter include a broad range of healthcare and health IT organizations, including the American Academy of Family Physicians, athenahealth, DirectTrust, AMIA, McKesson and Oracle.

I’m not going to list all the questions they’ve asked. You can read the entirety yourself. However, I will share two questions and offer responses of my own. One critical question is:

  • What is information blocking and what is not?

I think most of us know what the law is trying to accomplish, e.g. foster the kind of data sharing needed to accomplish key research and patient care outcomes goals. And the examples of what it considers information blocking make sense:

  • Practices that restrict authorized access, exchange, or use [of health data] under applicable State or Federal law
  • Implementing health information technology in nonstandard ways that are likely to substantially increase the complexity or burden of accessing exchanging or use of electronic health information
  • Implementing health information technology in ways that are likely to lead to fraud, waste, or abuse, or impede innovations and advancements health information access, exchange, and use

The problem is, there are many more ways to hamper the sharing of electronic health data. The language used in the law can’t anticipate all of these strategies, which leaves compliance with the law very much open to interpretation.

This, logically, leads to how businesses can avoid running afoul of the law:

  • The statute institutes penalties on vendors to $1 million per violation. How should “per violation” be defined?

    Given the minimum detail included in the legislation, this is a burning question. Vendors need to know precisely whether they’re in the clear, violated the statute once or flouted it a thousand times.

After all, vendors may violate the statute

  • When they refuse data access to one individual within a business one time
  • When they don’t comply with a specific organization’s request regardless of how many employees were in contact
  • When a receiving organization doesn’t get all the data requested at the same time
  • When the vendor asks the receiving organization to pay an administrative fee for the data
  • When individuals try to access data through the web and find it difficult to do so

Would a vendor be on the hook for a single $1 million fine if it flat out refused to share data with a client?  How about if it refused twice rather than once? Are both part of the same violation?

Does the $1 million fine apply if the vendor inadvertently supplies corrupted data? If so, does the fine still apply if the vendor attempts to remedy the problem? How long does the vendor have to respond if they are informed that the data isn’t readable?

What about if dozens or even hundreds of individuals attempt to access data on the web can’t do so? Has the vendor violated the statute if it has an extended web outage or database problem, and if so how long does it should have to get web-based data access back online? Does each attempt to access the data count as a violation?

What standard does the statute establish for standard vs. non-standard data formats?  Could a vendor be cited once, or more than once, for using a new and emerging data format which is otherwise respected by the industry?

As I’m sure you’ll agree, these are just some of the questions that need to be answered before any organization can reasonably understand how to comply with the law’s information blocking provisions. Asking regulatory agencies to clarify their expectations is more than reasonable.

DirectTrust, CHIME Deal Not All It’s Cracked Up To Be

Posted on September 7, 2017 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.

Recently, CHIME and DirectTrust announced a deal that sounded pretty huge on the surface. In a joint press release announcing the agreement, the two organizations said they had agreed to work together “to promote the universal deployment of the Direct Trust framework and health information exchange network as the common electronic interface for health information exchange across the U.S.”

Their plans include making the Direct exchange network available anywhere they can, including hospitals, medical practices, pharmacies, labs, long-term care facilities, payers, insurers and health departments, and to top it off, on applications. If things go the way they planned, you’ll hardly be able to kick a health IT rock without finding Direct under it.

As I noted earlier this year, DirectTrust is on something of a roll. In May, it noted that the number of health information service providers who engaged in Direct exchanges grew to almost 95,000 during the first quarter of this year. That’s a 63% increase versus the same period in 2016. The group also reported that the number of trusted Direct addresses which could share PHI grew 21%, to 1.4 million, and that there were 35.6 million Direct exchange transactions during the quarter, up 76% over the same period last year.

Sounds good. But let’s not judge this in a vacuum. For example, on the same day DirectTrust released its first quarter results, the Sequoia Project kicked out a press release touting its performance. In the release, Sequoia noted that its Carequality initiative was under full steam, with more than 19,000 clinics, 800 hospitals and 250,000 providers using the Carequality Interoperability Framework to share health data.

In considering the impact of Carequality, let’s not forget that late last year it connected with rival interoperability group CommonWell Health Alliance. I don’t know if you can say that interoperability effort can corner a market– the organizations using the rival health data sharing networks probably overlap substantially—but it’s certainly an interesting development. While the two organizations were both allied with a leading EMR vendor (CommonWell with Cerner and Carequality with Epic), the agreement has effectively brought the muscle of the two EMR giants together.

I guess it’s fair to say that the Carequality alliance and DirectTrust may own interoperabililty for now, rivaled only by the stronger regional HIEs.  That’s pretty impressive, I admit. Also, it’s interesting to see an accepted health IT organization like CHIME throw its weight behind Direct. I wouldn’t have expected CHIME to dive in here.

That being said, when you get down to it, none of the groups’ capacity for sharing health data is as great as it sounds. For example, if Epic’s Care Everywhere exchange only transmits C-CDA records, you have to ask yourself if Carequality is working at a higher level. If not, we’re in “meh” territory.

Bottom line, it seems clear that these organizations are winning the battle for interoperability mindshare. Both seem to have made a fair amount of progress. But between you and me in the lamppost, let’s not get excited just yet.

E-Patient Update: Enough Apps Already

Posted on September 1, 2017 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.

New data suggests that while app use is becoming a core activity for mobile, the number of apps people use is dropping. In fact, over the longer term, analysts say, most businesses will need to slim down the number of apps they deploy and do more to retain app users.

Speaking as someone who relies on apps to manage her health, I certainly hope that this happens among healthcare providers.

Maybe you think of my contact with your organization as a series of distinct interactions, and the data something that can be reintegrated later. All I can say is ”Please, no.” I want every digital contact I have with your organization to be part of a large, easy-to-navigate whole.

In fact,  I’ll go further and say that if your organizations offer a single, robust app that can offer me broad access to your administration, clinical departments and patient data I’ll choose you over your competitors any day.

Health app overload

As you may know, the number of health-related apps available on the Google Play and iTunes stores has grown at a dizzying pace over the last few years, hitting approximately 165,000 across both platforms as of two years ago. Most of these are were created by independent developers, and only a small percentage of those apps are downloaded and used regularly, but it’s still a stat worth considering.

Meanwhile, new data suggests that the field is going to narrow further among apps of all types. According to research from Business Insider, somewhere between 10% and 12% of app users remain engaged with those apps within seven days of installing them. However, that percentage drops to around 4% within just 30 days.

These trends may force a change in how healthcare organizations think about, develop and deploy apps for their end users. As users think of apps as utilities, they will have little patience for using, say, one for your cardiology department and another for sleep management, not to be confused with a third portal app for downloading medical information and paying bills.

If you’re part of an institution with multiple apps deployed, this may sound discouraging. But maybe it’s not such a bad thing after all.  Consumers may have less patience for a fragmented app experience, but if you produce a “power tool” app, they’re likely to use it. And if you play your cards right, that may mean higher levels of patient engagement.

My ideal health app

Having slammed the status quo, here’s what I’d like to see happen with the apps developed by healthcare organizations. I believe they should work as follows:

  • Providers should offer just one app for access to the entire organization, including all clinical departments
  • It should have the ability to collect and upload patient-generated data to the EMR
  • It should provide all features currently available through existing portals, including access to health data, secure email connections to providers, appointment-setting and bill payment
  • It makes all standard paperwork available, including informed consent documentation, pre-surgical instructions, financial agreements and applications for financial aid and Medicaid
  • It generates questions to ask a provider during a consult, before an imaging procedure, before, during and after hospitalization

I could go further, but I’m sure you get the idea: I’d like my providers’ apps to improve my health and foster my relationship with them.  To make that happen, I need a single, unified entity, not a bunch of separate modules that take up space on my phone and distract me from my overall goals.

Of course, one could reasonably observe that this turns a bunch of small lightweight programs into a single thick client. I’m sure that has implications for app coding and development, such as having to ensure that the larger apps still run reasonably quickly on mobile devices. Still, smartphones are ridiculously powerful these days, so I think it can still happen.

Like it or not, consumers are moving past the “there’s an app for everything ” stage and towards having a few powerful apps support them. If you’re still developing apps for every aspect of your business, stop.

IT Leaders Question Allscripts Acquisition of McKesson EIS

Posted on August 31, 2017 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.

Not long ago, I shared the results of a poll featured on HISTalk on the potential benefits of the Allscripts acquisition of McKesson EIS. The poll asked readers “Who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?”

Roughly equal numbers of respondents said Allscripts customers would benefit (29%) and McKesson customers (27%). However, a new research report from Reaction Data suggests that many of their peers doubt that things will work out for McKesson customers or even do much to build Allscripts’ market position.

A number of health IT leaders quoted in the report say they’re fearful that McKesson solutions will get short shrift under Allscripts management. Others suggest that both vendors are behind the curve, especially McKesson, and that Allscripts is unlikely to spend enough money on it to catch up to current standards.

Their comments included the following observations:

  • I don’t see Allscripts as a major player in this space anymore and the acquisition will likely further stress the enterprise. Perhaps in combination they can cobble together a suite of tools, but integration will likely be clunky at best for some time.” – CIO
  • I do not see that McKesson brings anything beneficial to Allscripts, other than more users. McKesson’s products are very different from Allscripts’ current products and so will further dilute their efforts to bring quality product forward.” –CFO
  • McKesson is behind. Does not look like a smart choice moving forward.” –Director of IT
  • Just like Cerner buying Siemens, we were told they would support it and yada yada, here we are on Cerner after having to drop much more cash than we should have been required to.”—CIO

it’s worth noting, for the record, that all the feedback on the acquisition wasn’t negative. Positive comments included the following:

  • Combining Paragon, as the only true integrated, Microsoft SQL-based, hospital and ambulatory HIS on the market, with a solid vendor that focuses exclusively on HIT, is a win-win for the healthcare industry.” – CIO
  • “McKesson was losing and continues to lose ground on EHR systems to Epic and Cerner. They are withering on the vine. This acquisition will help them solidify their position in the market.”– Vice President of Finance

Still, most health IT leaders seemed to think the deal wouldn’t help either party that much. In particular, they were skeptical that McKesson’s high-profile Paragon solution was salvageable. “Paragon…is antiquated,” wrote one manager of information technology. “It will take a big bag of money and a lot of time to fix that.”

To summarize, while HIT execs conceded that the merger might buy Allscripts some customers and time, they felt it wasn’t likely to benefit their organizations. In fact, some argued that the deal could actually undercut the future of their McKesson systems: “Allscripts may focus on their own EMR and how those products I have with McKesson will interact with them rather than on McKesson products as a whole,” worried one director of information technology.

On top of everything else, the previous analysis by HISTalk doesn’t inspire much confidence that the acquisition will work on a corporate level. The analysis asserts that EMR vendors should be judged by the number of 250+ bed hospitals they have as customers, and points out that Allscripts controls only 6% of that market. (Epic, in contrast, has 20%, the article notes, citing HIMSS Analytics data.)

If I’m reading this right, it seems that Allscripts will take two mediocre and/or unfashionable solution sets and try to crossbreed them into a more popular set of tools, in the process scaring whatever loyal customers they have left. All sarcasm aside, I’d like to ask: Has this ever worked before?

Are EMR Vendors Really This Clueless?

Posted on August 24, 2017 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.

I know that EMR vendors don’t always understand their end-users as well as they should. That’s a shame, but it’s likely to happen given how far apart their day-to-day lives are. Still, I was truly taken aback by the following.

In the introduction to a report on nurse perceptions of EHRs, researchers shared some words on their market research philosophy. I don’t think the writers intended to criticize anyone, but nonetheless, the vendors don’t come out looking very good in the process.

“Some (mainly vendors) have questioned why we conduct research to front-line users of core HIT systems, such as physicians, nurses, billers, schedulers etc.,” they wrote. “They argue that only the high-ranking decision-makers matter when it comes to tracking customer satisfaction (NPS) and winning a greater piece of the market. We’ve had senior leaders among prominent vendors essentially tell us that they don’t care about what frontline users have to say.”

Okay. (Taking a breath, letting out the bad air, taking in the good.) I don’t wanna go off on a rant here, but are those vendors completely stupid?  Are they trying to destroy whatever credibility they have left among end users?  Are they hinting that we should just sell their companies’ stocks short and live in the Bahamas the rest of our days?

To be clear, the researchers actually put a reasonably cheerful spin on all of this. They suggest, ever so politely, that if vendors pay attention to end users, they will “unlock a competitive gold mine.”  “Yes, it would require additional development resources, adjusting some roadmap goals, and resetting internal expectations, but the payoff is a quantifiable Unique Selling Proposition that just doesn’t exist very often in HIT – having a highly-rated platform among users,” they note, quite reasonably.

Being me, however, I’ll be a bit less nice. Vendors, I’m amazed we still have a health IT industry if that’s really how your leaders really think. It takes a uniquely dumb organization to keep selling products the actual users hate, and an even dumber one to ignore user feedback that could fix the problem.

While healthcare organizations may have rammed a jerry-rigged mess down users’ throats for a while, that can’t last forever — in fact, the day of reckoning is coming soon. As EMR users become more confident, wired and demanding, they’ll demand that their systems actually work for them. Imagine that!

This reckoning won’t just impact your future plans, it will come to bite you now.

If you were hoping to turn your multi-year contract into a nice, fat revenue stream, forget it. Users will scream (and inflict some pain) if the EMR is lousy to use. In a population health-based world calling for everyone to be clinical data power users, they’ll have far more clout. You’ll either spend tons of time fixing and updating things or lose your contract if your customer has an out. Either way, you’ve hollowed out your revenue stream. Good luck with that.

Nurses Still Unhappy With EHRs

Posted on August 21, 2017 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 new research report looking at nurses’ perceptions of EHRs suggests that despite countless iterations, many still don’t meet the needs of one of their key user groups. While the statistics included in the report are of some value, the open text responses nurses shared tell a particularly important story of what they’re facing of late.

The study, which was conducted by Reaction Data, draws on responses from 245 nurses and nurse leaders, 85% of whom work for a hospital and 15% a medical practice. Categories in which the participants fell broke out as follows:

* Nurses                                          49%
* CNOs                                            18%
* Nurse Managers                           14%
* Directors of Nursing                     12%
* Nurse Practitioners                       2%
* Informatics Nurse                         2%
* VP of Nursing                               2%
* Director, Clinical Informatics        1%

As with most other research houses, Reaction gets the party started by offering a list of vendors’ market share. I take all of these assessments with a grain of salt, but for what it’s worth their data ranks Epic and Meditech at the top, with a 20% market share each, followed by Cerner at 18%, Allscripts with 8% and McKesson with 6%.

The report summary I’ve used to write this item doesn’t share its stats on how the nurses’ ranked specific platforms and how likely they were to recommend those platforms. However, it does note that 63% of respondents said their organization wasn’t actively looking at replacing their EHR, while just 17% said that their employer was actively looking. (Twenty percent said they didn’t know.)

Where the rubber really hit the road, though, was in the comments section. When asked what the EHR needed to improve to support them, nurses had some serious complaints to air:

  • “Many aspects, too many to list. Unfortunately we ‘customized’ many programs, so they don’t necessarily speak to each other…” —Nurse Manager
  • “When we purchased this system 4 years ago, we were told that everything would be unified on one platform within 2 years, but this did not happen and will not happen.” –CNO
  • “Horrible and is a patient safety risk!” –RN
  • “Coordination of care. Very fragmented documentation.” –CNO

So let’s see: We’ve got incompatible modules, questionable execution, safety risks and basic patient care support problems. While the vendors aren’t responsible for customers’ integration problems, I’d find this report disheartening if I were on their team. It seems to me that they ought to step up and address issues like these. I wonder if they see these things as their responsibility?

In the meantime, I’d like to offer a quick postscript. The report’s introduction makes a point of noting – rightly, I think – that the inclusion of a high percentage of non-manager nurses makes the study results far more valuable. Apparently, not everyone agrees.

In fact, some of the vendors the firm met with said flat out that they only want to know what executives have to say – and that other users’ views didn’t matter to them.

Wow. I won’t respond any further than to promise that I’ll stomp all over that premise in a separate column. Stay tuned.