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2018 Practical Innovation Award Winner: ENGINUITY

Posted on July 25, 2018 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.

As the vision for the Health IT Expo came into view, we realized how valuable it was for the Health IT Expo community to learn about and share practical innovations that were happening in healthcare IT. As part of that effort, we announced the 2018 Practical Innovation Awards. Being the first year, we only had a short time to promote it and get the word out about it. With that said, we’re extremely pleased with the practical innovations that the 2018 Practical Innovation Award Winner has brought to the healthcare IT community and we’re excited to share those with you.

So, without further ado, we’re excited to announce the 2018 Practical Innovation Award Winner is ENGINUITY run by Kelly Del Gaudio, Principal Consultant, Galen Healthcare Solutions and was implemented at Freeman Health System, Valley Health System, and Canton – Potsdam Hospital System. This is a well-deserved honor for Kelly Del Gaudio and the team that worked on this project. Congratulations!

While awards and recognition are great, they don’t mean much if we don’t share the details of the practical innovations that won the award. In order to share more details about ENGINUITY (originally named Project Claire[IT]), we thought an interview with Kelly Del Gaudio would be a great way to share what they accomplished and hopefully help to spread their experiences, insights, and innovations.

Tell us about Project Claire[IT].  How was it started and who was involved?

Project Claire[IT] was what we originally called ENGINUITY. It was a project in honor and memory of my friend and Rule writing mentor at MEDITECH, Claire Riemer. Claire was the original pioneer of the MEDITECH rules engine and led the Clinical Content group there for many years.

The idea for this project started about a few months after I came on as the Principal Consultant for MEDITECH at Galen Healthcare Solutions. Since I had a lot of experience with the MEDITECH Rules engine from people like Claire, and working on a Clinical Optimization Performance Team during my 10 years at the “Tech”, I decided to host a free “Rule Writing 101” webinar that would give users a basic understanding of the MEDITECH Rules engine and offer tips and tricks on how to write some basic rules. We were surprised when we saw the signup list the day of the webinar (which ended up being our highest attended to date), and soon after, the flood gates opened with questions from MEDITECH users asking for help with Rules they’ve been stuck on for weeks, months and sometimes years!

Many of the questions we received were similar (people needing help with calculations, VTE compliance, Problem List Management etc) so we thought maybe we could streamline the process and write the complex rules that everyone seems to need for them; or as we call it: Doing their NerdyWork. Galen was no stranger to this as we have been successful in creating and delivering a similar solution to our Allscripts clients called eCalcs.

I knew I had the unique skill set to write the Rules that these customers needed, but not being a nurse or clinician by trade (although I can occasionally fake it til’ I make it) I knew I needed their help to understand exactly what their frustrations were from both a clinical and IT perspective. The only logical conclusion was to host a focus group, and so our first Galen Focus Group: Operation NerdyWork was born.

Operation NerdyWork was a group of nine MEDITECH hospitals all running MEDITECH’s 6.x/6.1 or higher platform. They represented various areas of the country, from cities to rural/remote, from large Health Systems to small Critical Access satellites. It seems that no matter how big (or small) your IT staff was, the Rules Engine was a bit of a black box for everyone.

Here is our elite nine:

  • Catholic Health Initiatives
  • Salinas Valley Medical Center
  • Randolph Hospital
  • Uvalde Memorial Medical Center
  • Freeman Health System
  • Canton-Potsdam Hospital
  • Peterson Reginal Medical Center
  • Calvert Memorial Hospital
  • Parkview Medical Center

These groups offered their time on Thursdays during the winter of 2016 and provided us with valuable insights into the world of a MEDITECH doctor, nurse, care provider, or pharmacist. From their list of frustrations, we got to work building better, rule driven workflows that will save time, reduce clicks, increase compliance and patient safely and present users with much needed clinical decision support.

We decided to call our platform ENGINUITY because we use the MEDITECH Rules Engine to code a lot of our custom content. It’s also a derivative of the word ingenuity which is the quality of being inventive, clever, resourceful; thinking outside of the box. We pride ourselves on coming up with really clever ways to achieve something that may otherwise be “Working as Designed”. ENGINUITY continues to be crowdsourced and we receive suggestions every day from users of our content. MEDITECH customers drive the future direction of this product because hey, they’re the one that have to use it right?

What have been the practical benefits of this project?

Practical Innovation is all about solutions that can be implemented now that bring value to an organization. We think we are doing just that.

By streamlining the lengthy design process that many of these rules take to write and creating a plug and play solution that has been tested, validated, and thoroughly researched, we can confidently help hospitals achieve optimal compliance, increased patient and provider satisfaction, EMR confidence, realize revenue gains and so much more. If you wanted to implement some of these complex tools outside of ENGINUITY, not only would you need at least one full time dedicated FTE on these projects, but that person would need to have an advanced Rule writing skill set which is not easy to find. You would also need to keep those people on staff to troubleshoot Rules that are subject to change during much needed updates or future workflow changes.

I actually spoke with a client at last year’s MUSE conference who told me that their resident “Rules” person was about to retire so they stopped optimizing their system because she was the only one who could support it. I used this anecdote the next day at our official launch presentation and realized that this was more common than I thought. Rules are complex and there are a lot of unknowns but they are far and away the most efficient way to optimize the your MEDITECH system which is why everyone should have them!

ENGINUITY makes these options an affordable reality for many organizations that simply don’t have the time, capital or resources. The Galen team supports all of our content post-implementation, so our clients can worry about daily system support and education.  ENGINUITY customers also determine “what’s next” in our dev cycle and are always receiving the fruit of our development efforts keeping their system optimized, refreshed and functional for years to come.

What were the keys to success with this project? 

I attribute the success of this project to 5 main things.

  1. First, having a deep understanding of the technical underpinnings of the MEDITECH Rules Engine is crucial to the success of ENGINUITY. I have always been fascinated with trying to figure out this puzzle and I continue to learn more about it daily. For me, it’s fun; for most, its frustrating. Thank you Claire Riemer, Ginny Jacques and Nancy McGowan for teaching me this craft.
  2. Second, having the support of the Galen Healthcare Solutions team. They let me run with this idea to design, develop and mass deliver content to clients who need it and they’ve fully supported it through its infancy to now. We are KLAS ranked and on Modern HealthCare’s Best Places to Work for a reason and I know working at Galen was one of the best decisions I have ever made. I firmly believe that autonomy, support and confidence is really what helps innovation to thrive.
  3. Third, our focus group. They are the ones who brought the ideas to the table and got the ball rolling. Thank you Operation NerdyWork!
  4. Fourth, our ENGINUITY clients who push us and challenge us with new puzzles every day. Their challenges (though sometimes daunting) make us better in the long run.
  5. Finally, getting the word out in major healthcare IT publications! Having published articles that recognize our unique approach to customer collaboration and feature our MU3: Measure 3 content really help to spread the word about what we’re doing.

How does this project impact patients?

We put a lot of effort in the design process of a workflow to make it easy for the doctor/user to use. Many of our tools are “single-click” meaning that as soon as I “click” on something (a query or order) then the algorithm will “fetch” necessary data and bring that to the providers attention immediately. We can suggest, require, suppress or automate responses based on preexisting information which makes ENGINUITY very patient centric. This added clinical decision support is embedded directly into the MEDITECH system (not 3rd party) which significantly increases the confidence that users have in the messages they are receiving. We can then use a combination of hard stops, soft stops, alerts and audit trails to increase patient safety across the board.

We’re currently working on a case study of before and after Implementation of our VTE Compliance protocol, which was designed using the AHRQ’s Best Practice recommendations for VTE Prophylaxis compliance. It is estimated at increasing organizational compliance to over 90% which will significantly impact the lives of many surgical inpatients.

I also worked with some of our product development folks from our VitalCenter Online Archival team to create a way to have Rules evaluate patient Problems and drive care off the Problem List. From my research, this is not just a MEDITECH problem, (pun intended) but it spans across all EMRs leaving most Problem Lists “static”. We are changing that for our MEDITECH clients by driving and automating care off the Problem List making it a truly “dynamic” list.

You call the effort “Operation NerdyWork”.  What’s been your experience getting “nerds” together to collaborate on a solution like this?

Operation NerdyWork was all about bringing a diverse group of people together with some commonalities (trades, users of MEDITECH) and working together toward a common goal. Listening to each other’s pain points and sometimes even solving each other’s problems without my help at all (which was really fun to see). Everyone brought a unique voice to the table. As innovators, the best we can do is shut up and listen, hear what people want and develop what they need.

What practical advice would you give health IT professionals that will help them be more successful in their work?

Find something you’re good at, something you’re passionate about, something that keeps you up at night but also helps you rest easy knowing you could be a part of the solution. When you’ve found it then surround yourself with supportive people and get busy on the Nerdywork.

A big Congratulations to the 2018 Practical Innovation Award Winner: ENGINUITY

How Nursing Informatics is Changing the Healthcare Landscape – #HITsm Chat Topic

Posted on June 26, 2018 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 6/29 at Noon ET (9 AM PT). This week’s chat will be hosted by Cathy Turner (@MEDITECH_Nurses) and Ashley Dauwer (@amariedauwer) from @MEDITECH on the topic of “How Nursing Informatics is Changing the Healthcare Landscape.”

When it comes to treating patients, there is one constant: the critical role that nurses play in delivering quality care. As care becomes more complex and stretches far beyond the acute hospital walls, nursing roles will continue to evolve. The nursing informaticist role emerged at the unique junction between healthcare and technology. Nursing informaticists are essential because they serve as an advocate between nurses directly caring for patients and information technology experts, helping to implement and optimize information technology to transform healthcare.

Two weeks ago hundreds of nurses convened at MEDITECH’s annual Nurse Forum. Year after year I am impressed with how our community of nurses come together to discuss how new technologies can address challenges and obstacles facing nurses today. It’s important for nurses to leverage events and social media to network, share successes, and demonstrate how they are embracing technology to impact patient care.

Resources:

Join us for a lively discussion at this week’s #HITsm chat as we explore these themes and discuss the following questions:

T1: What is nursing informatics and what does it mean to you? #HITsm

T2: How are nursing informaticists influencing changes in healthcare? #HITsm

T3: What technologies are improving patient care and nursing workflows? #HITsm

T4: What tips or advice do you have for new nursing informaticists? #HITsm

T5: How can social media help nurses in their healthcare career? #HITsm

Bonus: For the nurses, who is your biggest inspiration and why? For the non-nurses, name a nurse that inspires you and why. #HITsm

Upcoming #HITsm Chat Schedule
7/6 – What’s the Future of Patient Communication?
Hosted by Lea Chatham (@LeaChatham)

7/13 – TBD
Hosted by TBD

7/20 – TBD
Hosted by Jared Jeffery (@Jk_Jeffery)

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Be Skeptical About Health IT Research Reports

Posted on April 26, 2018 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.

Look, I get it. While advice from colleagues is fine, it’s even better to have an objective research organization tell you which vendors dominate the market and which seem to have a lot of fans.

You know some of the headlines, in big bold letters: “Epic has the biggest EMR market share in the US” or “Doctors are very satisfied with eClinicalWorks.” Hey, if nothing else, you can wave the report in your boss’ face if your new system doesn’t work out.

The thing is, are you getting valuable, fair, unbiased feedback from research vendors? Not necessarily.

  • Pay for play: Some research firms are getting paid to promote certain products or organizations in their reports and client notes. The payment can be as subtle as a few introductions to potential customers or a straight up bundle of cash. Sadly, not all analyst firms who engage in this practice will tell you that they do.
  • Lack of experience: While some research reports are written by senior people with a long institutional memory, sometimes they are farmed out to junior staff members with a lot less perspective. I’m not suggesting that the younger people get it wrong, but they simply can’t offer the kind of insight senior people can.
  • Beauty contests: Be warned: sometimes reports are just not about you. It may appear, on the surface, that the research firm is offering you valuable insights, but the truth is that the research isn’t that substantial. In cases like these, the firms simply line up all the vendors in a row and rate them on scales they basically make up in their head.
  • Value of the data: Sure, it’s sort of fun and interesting to know whether Epic has nudged out Cerner or MEDITECH in the battle for US market share. It’s something to share over the health IT water cooler. And it seems to give you a sense of which vendors are offering the most value. But does it really? In most case, it probably isn’t that helpful to track market share unless you hold stock in one of these companies.

For what it’s worth, I’ve written several in-depth research reports of my own, and I feel pretty good about the industry analysis I did. But thankfully, none of the publishers suggested that I was the Oracle of truth. I simply gathered up a pile the facts and tried to fit them together.

In saying all this, I’m not suggesting that health IT industry research is a waste of time. If a report offers context, input from your peers and no-nonsense answers to questions you have, it may well be worth the price. But don’t let one of these firms sell you a bunch of hot air.

 

Connecting and Meeting Up with People at #HIMSS18

Posted on February 14, 2018 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.

The 2018 HIMSS Annual Conference is just over 3 weeks away. For those not familiar with the event, it’s the behemoth of healthcare IT conferences which brings together 40,00-50,000 attendees and 1300 exhibitors at the Sands Convention Center in Las Vegas. It’s a week long healthcare IT extravaganza where you can connect with a wide variety of people from across the industry. However, it can no doubt be overwhelming for those attending for the first time (or even the 20th time for that matter).

If you talk to anyone who attends conferences regularly, they usually comment that the best part of the conference is spending time engaging with attendees and learning from their experience. This idea resonated so much with me that last year I decided to put together a series of meetups at HIMSS17. It was a smashing success of engagement, learning, and connection. After that success, we’re back with a wonderful schedule of meetups at HIMSS18 as well.

These meetups are open discussions. We generally feature a panel of influencers, thought leaders, and all-around interesting people who can make sure everyone gets a lot of value from the meetup. However, we want you to get involved as well. At these meetups, we encourage questions and comments from the audience so we can all learn and share with each other. We hope you’ll join us to share your insights, experiences, and perspectives and learn from others in the community.

So, without further ado, here’s our schedule of meetups at the HIMSS 2018 Annual Conference! Only the New Media Meetup requires registration. All of the rest you can just show up and attend.

Tuesday, March 6, 2018 HIMSS Meetups

Physician Communication Meetup
Tuesday, 3/6, 11:00-11:45 AM at the Voalte Booth #7131
Coordinating communication among care teams is a challenge every hospital faces. One of the most difficult aspects is how to manage physician communication. Bringing physicians into the care team communication loop can improve care, lower costs and increase efficiency. Join Danielle Siarri (@innonurse), Shahid Shah (@ShahidNShah), Angela Kauffman (@Voalte), Andrew Burchett, DO (@drandrew76), Candace Capps (@lbsolutions), and Colin Hung (@Colin_Hung) for a discussion about the challenges of physician communication and how to overcome them.

Consumer Solutions for a Positive, Healthier Patient Experience Meetup
Tuesday, 3/6, 12:50-1:35 PM at the MEDITECH Booth #1360

Do your patients feel connected to their physicians and other healthcare providers? Do they feel they are being listened to, and do they have access to the information they need to stay healthy and engaged? Join this meetup with Helen Waters (@HelenMEDITECH), Andrew Burchett, DO (@drandrew76), Max Stroud (@MMaxwellStroud), Lygeia Ricciardi (@Lygeia), Randy McCleese (@McCleeseRandy), and John Lynn (@techguy) where we’ll discuss how the MEDITECH patient portal and MHealth Apps keep patients informed and connected using features like direct appointment booking, provider messaging, integration with wearables, online questionnaires, and more. We’ll also talk about embedded video visits and how they provide patients with a personal and convenient means of interacting with their own physicians.

Data Hygiene in Healthcare: The First Step to Getting Value Out of Your Data Meetup
Tuesday, 3/6, 2:00-2:45 PM at the DellEMC Booth #3613

Digital transformation is happening in healthcare. With digitization, comes automation. With automation comes more applications. With more applications, comes more data. ‘Dirty data’ might cost you more than you realize…especially when it’s stored in legacy applications that are not managed well. Join the discussion with David Dimond (@NextGenHIT), Dan Trott (@DanTrottDell), Geeta Nayyar, MD (@gnayyar), Linda Stotsky (@EMRAnswers), Michael Joseph (@HealthData4All), James Lowey (@loweyj), Dr. Nick van Terheyden (@drnic1), Michael Archuleta (@Michael81082), and John Lynn (@techguy) and share your insights into this important topic.

HIMSS Social Media Ambassador Meetup
Tuesday, 3/6, 3:00-3:45 PM at the HIMSS Spot, Level 2, Lobby C

We’re honored that two of Healthcare Scene’s bloggers, @colin_hung and @coherencemed, were selected as 2 of 20 HIMSS Social Media Ambassadors. This is a select group of some of the most influential people in healthcare IT social media. This meetup organized by HIMSS will bring together the 20 social media ambassadors to talk about insights into healthcare IT, HIMSS18, and social media.

Wednesday, March 7, 2018 HIMSS Meetups

Data Innovation: Machine Learning and Artificial Intelligence in Healthcare – it’s happening… Meetup
Wednesday, 3/7, 11:00-11:45 AM at the DellEMC Booth #3613

It’s no secret, the healthcare industry has an (over) abundance of data. There are lots of mergers/acquisitions and consolidations taking place in the industry which only complicates matters and intensifies the playing field. There is likely a ton of analysis that’s not currently being done that could potentially provide better insights and results for healthcare organizations—their doctors, researchers, and patients. Now that we have the data, how do we make it useful? How can we deploy machine learning and artificial intelligence technologies into driving better results in a healthcare environment? How do you take the data and make it actionable? We invite you to join Geeta Nayyar, MD (@gnayyar), Dr. Nick van Terheyden (@drnic1), James Lowey (@loweyj), Michael Archuleta (@Michael81082), and John Lynn (@techguy) to discuss this hot topic.

#HITsm and #hcldr Picture and Meetup
Wednesday, 3/7, 12:15-12:45 PM (or however long people hang out) in the Sands Lobby downstairs by the large HIMSS sign/statue

This year we decided to keep things really simple for our #HITsm and #hcldr meetup at HIMSS 2018. Join us by the massive HIMSS letters/statue/sign to take a community picture with the sign and then mix and mingle with members of the #HITsm and #hcldr communities. We’ll plan to take the picture about 12:30 and then the rest of the time we’ll just enjoy seeing old friends, meeting new ones, and finally meeting some people who feel like old friends that we’re just meeting for the first time.

Finding the Right Mix of Human and Tech in a Unified Communication Strategy Meetup
Wednesday, 3/7, 1:00-1:45 PM at the Stericycle Communication Solutions Booth #859

Creating an effective unified communication strategy in healthcare requires an effective balance between human and tech.  Do you prefer to call and schedule an appointment or schedule one online?  The challenge in healthcare is the answer to that question depends on the patient.  Sometimes a phone call is necessary while other times the ability to schedule an appointment online is much more convenient.  Join Sarah Bennight (@SarahBennight), Janae Sharp (@CoherenceMed), Brian Mack (@BFMack), Melody Smith (@TheSameMel), and John Lynn (@techguy) as we discuss an effective unified communication strategy that incorporates both humans and technology.

New Media Meetup
Wednesday, 3/7, 6:00-8:00 PM at Senor Frogs (Inside Treasure Island Casino across the street from Venetian)
This is the 9th annual New Media Meetup at HIMSS. This event brings together most of the influential people in Healthcare IT social media and a wide variety of influencers, journalists, bloggers and readers as well. Plus, thanks to our sponsor, CareCognitics, we’ll have food, drinks, a DJ, and some killer giveaways. This event does require you to register to attend, so please be sure to register if you plan to join us.

Thursday, March 8, 2018 HIMSS Meetups

How AI Will Impact the Patient Experience Meetup
Thursday, 3/8, 10:00-10:45 AM at the Pegasystems Booth #11336

We’re seeing AI (Artificial Intelligence) applied throughout healthcare, but one of the most exciting areas we’re seeing AI make a difference is in the patient experience.  What do patients expect?  How can AI be used to meet patients expectations?  What are the benefits and challenges of using AI with patients?  Join Susan Taylor (@pega), Chuck Webster, MD (@wareFLO), Tamara StClaire (@drstclaire), Prashant Natarajan (@natarpr), and Colin Hung (@Colin_Hung) as we look at the impact AI will have on the patient experience.

How’s that look for an incredible schedule of HIMSS 2018 meetups? We can’t wait to welcome you to Vegas and enjoy incredible engagement and knowledge sharing with those of you in the Healthcare IT and HIMSS18 community.

Voalte, MEDITECH, DellEMC, Stericycle Communication Solutions, Pegasystems, and CareCognitics are all sponsors of Healthcare Scene .

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.

One Hospital Faces Rebuild After Brutal Cyberattack

Posted on July 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.

Countless businesses were hit hard by the recent Petya ransomware attack, but few as hard as Princeton, West Virginia-based Princeton Community Hospital. After struggling with the aftermath of the Petya attack, the hospital had to rebuild its entire network and reinstall its core systems.

The Petya assault, which hit in late June, pounded large firms across the globe, including Nuance, Merck, advertiser WPP, Danish shipping and transport firm Maersk and legal firm DLA Piper.  The list of Petya victims also includes PCH, a 267-bed facility based in the southern part of the state.

After the attack, IT staffers first concluded that the hospital had emerged from the attack relatively unscathed. Hospital leaders noted that they are continuing to provide all inpatient care and services, as well as all other patient care services such as surgeries, therapeutics, diagnostics, lab and radiology, but was experiencing some delays in processing radiology information for non-emergent patients. Also, for a while the hospital diverted all non-emergency ambulance visits away from its emergency department.

However, within a few days executives found that its IT troubles weren’t over. “Our data appears secure, intact, and not hacked into; yet we are unable to access the data from the old devices in the network,” said the hospital in a post on Facebook.

To recover from the Petya attack, PCH decided that it had to install 53 new computers throughout the hospital offering clean access to its Meditech EMR system, as well as installing new hard drives on all devices throughout the system and building out an entirely new network.

When you consider how much time its IT staff must’ve logged bringing basic systems online, rebuilding computers and network infrastructure, it seems clear that the hospital took a major financial blow when Petya hit.

Not only that, I have little doubt that PCH faces doubts in the community about its security.  Few patients understand much, if anything, about cyberattacks, but they do want to feel that their hospital has things under control. Having to admit that your network has been compromised isn’t good for business, even if much bigger companies in and outside the healthcare business were brought to the knees by the same attack. It may not be fair, but that’s the way it is.

That being said, PCH seems to have done a good job keeping the community it serves aware what was going on after the Petya dust settled. It also made the almost certainly painful decision to rebuild key IT assets relatively quickly, which might not have been feasible for a bigger organization.

All told, it seems that PCH survived Petya successfully as any other business might have, and better than some. Let’s hope the pace of global cyberattacks doesn’t speed up further. While PCH might have rebounded successfully after Petya, there’s only so much any hospital can take.

MUMPS and Healthcare

Posted on May 11, 2017 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.

Leave it to David Chou to point out how odd it is to work in healthcare IT. What’s shocking about the image David Chou shared above is that there are so many languages listed. However, despite the vast number of languages listed, MUMPS is so far off the radar of most tech people that they literally didn’t care about it enough to add it to the chart. That’s pretty sad for those of us who care about healthcare.

If you want to get another view about the challenge of so much of healthcare being run on MUMPS, check out this MUMPS thread on Hacker News. For those not familiar with Hacker News, it’s a site that was started by YCombinator and has grown into a community of some of the most progressive tech startup people in the world. The Hacker News thread is really long, so for those who don’t want to read it all the message is simple: MUMPS? What’s that? That’s awful!

To be fair, there were a few dissenting voices who commented on the great features of MUMPS. However, I have to admit that these people sound a little bit like those who espouse the benefits of the fax machine. Sure, it has some extremely beneficial features, but it’s downsides far outweigh the benefits described.

The reality is that we’re not going to get away from MUMPS in healthcare. When you realize that Epic, MEDITECH, Vista (VA), and Intersystems all use some form of MUMPS (or M as they prefer to call it now), you can see why MUMPS will be part of healthcare for a long time to come.

What’s more disappointing to me after reading the Hacker News thread was how people described the culture of the EHR vendors that use MUMPS. They really described it as uninterested in even exploring other more modern options that could help them better able to innovate their products and serve their customers.

Plus, it also hurts to hear so many programmers in the thread talk about how they shunned healthcare because they saw working on something like MUMPS as a career killer. I’m sure this is a common refrain for most developers out there. It’s disheartening to think that many EHR vendors will never benefit from the best developers as long as we’re on MUMPS.

I’m sure MUMPS was great in its day. It seems to have been a wise choice by Epic to start using it when I was born back in 1979. However, can you imagine the technical debt that’s accumulated all these years? Is it any wonder that innovation in healthcare works so slow?

HL7 Releases New FHIR Update

Posted on April 3, 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.

HL7 has announced the release of a new version of FHIR designed to link it with real-world concepts and players in healthcare, marking the third of five planned updates. It’s also issuing the first release of the US Core Implementation Guide.

FHIR release 3 was produced with the cooperation of hundreds of contributors, and the final product incorporates the input of more than 2,400 suggested changes, according to project director Grahame Grieve. The release is known as STU3 (Standard for Trial Use, release 3).

Key changes to the standard include additional support for clinical quality measures and clinical decision support, as well as broader functionality to cover key clinical workflows.

In addition, the new FHIR version includes incremental improvements and increased maturity of the RESTful API, further development of terminology services and new support for financial management. It also defined an RDF format, as well as how FHIR relates to linked data.

HL7 is already gearing up for the release of FHIR’s next version. It plans to publish the first draft of version 4 for comment in December 2017 and review comments on the draft. It will then have a ballot on the version, in April 2018, and publish the new standard by October 2018.

Among those contributing to the development of FHIR is the Argonaut project, which brings together major US EHR vendors to drive industry adoption of FHIR forward. Grieve calls the project a “particularly important” part of the FHIR community, though it’s hard to tell how far along its vendor members have come with the standard so far.

To date, few EHR vendors have offered concrete support for FHIR, but that’s changing gradually. For example, in early 2016 Cerner released an online sandbox for developers designed to help them interact with its platform. And earlier this month, Epic announced the launch of a new program, helping physician practices to build customized apps using FHIR.

In addition to the vendors, which include athenahealth, Cerner, Epic, MEDITECH and McKesson, several large providers are participating. Beth Israel Deaconess Medical Center, Intermountain Healthcare, the Mayo Clinic and Partners HealthCare System are on board, as well as the SMART team at the Boston Children’s Hospital Informatics Program.

Meanwhile, the progress of developing and improving FHIR will continue.  For release 4 of FHIR, the participants will focus on record-keeping and data exchange for the healthcare process. This will encompass clinical data such as allergies, problems and care plans; diagnostic data such observations, reports and imaging studies; medication functions such as order, dispense and administration; workflow features like task, appointment schedule and referral; and financial data such as claims, accounts and coverage.

Eventually, when release 5 of FHIR becomes available, developers should be able to help clinicians reason about the healthcare process, the organization says.

Has Electronic Health Record Replacement Failed?

Posted on June 23, 2016 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Galen Healthcare.
Justin Campbell
A recent Black Book survey of hospital executives and IT employees who have replaced their Electronic Health Record system in the past three years paints a grim picture. Respondents report higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits of switching systems. Specifically:

  • 14% of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn’t support the total cost of their replacement EHR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive level respondents admitted they feared losing their jobs as a result of the EHR replacement process
  • 66% of system users believe that interoperability and patient data exchange functionality have declined

Surely, this was not the outcome expected when hospitals rushed to replace paper records in response to Congressional incentives (and penalties) included in the 2009 American Recovery and Reinvestment Act.

But the disappointment reflected in this survey only sheds light on part of the story. The majority of hospitals depicted here were already in financial difficulty. It is understandable that they felt impelled to make a significant change and to do so as quickly as possible. But installing an electronic record system, or replacing one that is antiquated, requires much more than a decision to do so. We should not be surprised that a complex undertaking like this would be burdened by complicated and confusing challenges, chief among which turned out to be “usability” and acceptance.

Another Black Book report, this one from 2013, revealed:

  • 66% of doctors using EHR systems did not do so willingly
  • 87% of those unwilling to use the system claimed usability as their primary complaint
  • 84% of physician groups chose their EHR to reach meaningful use incentives
  • 92% of practices described their EHR as “clunky” and/or difficult to use

None of this should surprise us but we need to ask: was usability really the key driver for EHR replacement? Is usability alone accountable for lost revenue, employment anxiety and buyers’ remorse? Surely organizations would not have dumped millions into failed EHR implementations only to rip-and-replace them due to usability problems and provider dissatisfaction. Indeed, despite the persistence of functional obstacles such as outdated technology, hospitals continue to make new EMR purchases. Maybe the “reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data,” wrote Dr. Donald Voltz, MD in EMR and EHR.

Interoperability is linked to another one of the main drivers of EHR replacement: the mission to support value-based care, that is, to improve the delivery of care by streamlining operations and facilitating the exchange of health information between a hospital’s own providers and the caregivers at other hospitals or health facilities. This can be almost impossible to achieve if hospitals have legacy systems that include multiple and non-communicative EHRs.

As explained by Chief Nurse Executive Gail Carlson, in an article for Modern Healthcare, “Interoperability between EHRs has become crucial for their successful integration of operations – and sometimes requires dumping legacy systems that can’t talk to each other.

Many hospitals have numerous ancillary services, each with their own programs. The EHRs are often “best of breed.” That means they employ highly specialized software that provides excellent service in specific areas such as emergency departments, obstetrics or lab work. But communication between these departments is compromised because they display data differently.

In order to judge EHR replacement outcomes objectively, one needs to not just examine the near-term financials and sentiment (admittedly, replacement causes disruption and is not easy), but to also take a holistic view of the impact to the system’s portfolio by way of simplification and future positioning for value-based care. The majority of the negative sentiment and disappointing outcomes may actually stem from the migration and new system implementation process in and of itself. Many groups likely underestimated the scope of the undertaking and compromised new system adoption through a lackluster migration.

Not everyone plunged into the replacement frenzy. Some pursued a solution such as dBMotion to foster care for patients via intercommunications across all care venues. In fact, Allscripts acquired dBMotion to solve for interoperability between its inpatient solution (Eclipsys SCM) and its outpatient EMR offering (Touchworks). dBMotion provides a solution for those organizations with different inpatient and outpatient vendors, offering semantic interoperability, vocabulary management, EMPI and ultimately facilitating a true community-based record.

Yet others chose to optimize what they had, driven by financial constraints. There is a thin line separating EHR replacement from EHR optimization. This is especially true for those HCOs that are neither large enough nor sufficiently funded to be able to afford a replacement; they are instead forced to squeeze out the most value they can from their current investment.

The optimization path is much more pronounced with MEDITECH clients, where a large percentage of their base remains on the legacy MAGIC and C/S platforms.

Denni McColm, a hospital CIO, told healthsystemCIO why many MEDITECH clients are watching and waiting before they commit to a more advanced platform:

“We’re on MEDITECH’s Client/Server version, which is not their older version and not their newest version, and we have it implemented really everywhere that MEDITECH serves. So we have the hospital systems, home care, long-term care, emergency services, surgical center — all the way across the continuum. We plan to go to their latest version sometime in the next few years to get the ambulatory interface for the providers. It should be very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it,” but we’ll decide when the time is right, she says.

What can we discern from these different approaches and studies?  It’s too early to be sure of the final score. One thing is certain though: the migrations and archival underpinnings of system replacement are essential. They allow the replacement to deliver on the promise of improved usability, enhanced interoperability and take us closer to the goal of value-based care.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

Video Interview with Helen Waters, VP at MEDITECH

Posted on January 29, 2016 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.

Healthcare Scene was lucky to sit down with Helen Waters, VP at MEDITECH, to talk about the EHR market and MEDITECH’s place in that market. Plus, we dive into the culture and history of MEDITECH and how it’s changed. We also explore MEDITECH’s plans around innovation, integration, and value along with MEDITECH’s efforts to deploy cloud and mobile solutions. Finally, we had to talk about healthcare interoperability. We hope you’ll enjoy this wide ranging interview with Helen Waters:

After the formal interview we did above, we allow people watching live to be able to ask questions and even hop on camera to offer their insights or ask questions of Helen in what we call the “after party.” In this “after party” discussion we talk to Helen about her thoughts on the changing healthcare reimbursement landscape and what MEDITECH is doing to prepare for it. We also talk about integrating telemedicine into MEDITECH. I also ask Helen about MEDITECH’s views on EHR APIs.

We hope you’ll enjoy this look into EHR vendor, MEDITECH.