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Yes, Healthcare IT Adoption Is Expensive AND Painful!

Posted on December 4, 2012 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

<Mandi’s Rant>

Few topics infuriate me as much as the notion that national standards-based implementation and adoption of healthcare IT should be cheap and easy. Haven’t we all heard the adage, “You can only have things done two of three ways: fast, cheap, or well”? Considering that the “thing” we’re trying to do is revolutionize the healthcare industry, the effects of which may be felt in each and every one of our lives at some point, don’t you want to include “well” as the bare minimum of what is required? After all, this is YOUR electronic health record, YOUR data, YOUR treatment plan and effectiveness measurements. So, what’s the other way we want this “thing” done: fast or cheap?

We’re talking about an industry that takes an average of 17 YEARS to put significant medical discoveries into routine patient care practice. (Numerous sources confirm this: The Healthcare Singularity and the Age of Semantic Medicine Translating Research into Public Health Action, etc.)

17 years is an entire generation of doctors. Doogie Howser could have been born, graduated med school, and begun to practice medicince by the time any insights from his birth were applied to practice. Suffice it to say, “fast” is not a way that healthcare is used to doing a “thing”.

Let’s contrast that with the information technology industry’s acceptance of iterative development releases and planned obsolescence for enterprise AND consumer assets. The big boys (Oracle, IBM, etc.) generally cease support of older products between 7-10 years after their introduction. Your company’s AS/400 server hardware may be 15 years old, but the O/S is the latest release, and all the data on the legacy server is preserved with the latest in backup packages over a wire-speed network connection. How long have you had your laptop? How frequently have you updated your Facebook app this year?

If someone tried to sell you a 17 year-old 480DX PC with a 9600 baud modem, 5″ floppy disk, 64MB RAM, running Windows 3.11 using the argument that, although much newer, faster, cheaper, more effective technology is available it is not yet PROVEN, would you buy it?

So, healthcare – an industry which moves at the speed of 17 years of Doogie Howser medical student maturity, and technology – an industry reinvented with the introduction of the iPhone in June of 2007, are at a crossroads for how to accomplish this “thing”: developing, implementing, and widely adopting national standards-based healthcare IT within mandated timelines that fall well within the next 10 years.

It must be done “fast”, relative to the usual pace of healthcare change.

And it must be done “well”, because it is OUR health at stake.

Suffice it to say, it will not be “cheap”. And my momma always told me that nothing worth doing is easy.

We have to stop whining about how costly and hard it is to turn this ship, and start working with the ONC on how to make healthcare IT better, faster, and ultimately more meaningful to all stakeholders involved in its use.

</Mandi’s Rant>

Random Thoughts: EMR Projects Decentralized; Problems Persist Despite ‘Solutions’

Posted on August 4, 2011 I Written By

Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?)

Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions.

This news comes on the heels of a decision by the government of Ontario to give up on hopes for a single EMR for all of Canada’s most populous province.

On the other hand, here in the States, we’ve seen a lot of consolidation among healthcare providers, but I’m guessing that has more to do with administrative Accountable Care Organizations and the prospect of bundled payments than any desire to build a more unified EMR. Though, consolidation does make health information exchange somewhat easier, and that’s going to be key to earning “meaningful use” dollars beyond 2013.

On a somewhat similar note, doesn’t a headline like, “Positive Outlook for Small Practice EHR Adoption” sound like a no-brainer? I mean, isn’t that the segment of healthcare providers that historically has had the slowest adoption rates? More than anyone else, small practices—particularly small, primary care practices—are the intended target of the federal EHR incentive program. And most of the news from health IT vendors of late has been about how they are going after this long-neglected market, right? The innovation seems to be happening in ambulatory EMRs, as evidenced by DrChrono’s newly certified iPad EHR app, aimed squarely at independent physicians.

That said, vendors and publicists, please do not start inundating me with news about other EHRs getting certified. There are hundreds of certified products out there now, and I cannot and will not write about, oh, about 95 percent of them.

While you’re at it, please stop using the word “solution” as a synonym for “product” or “service.” Tech journalists hate this trite, lazy and, frankly, inaccurate term so much that I’ve been instructed by the editors of InformationWeek not to use it, except in direct quotes. In fact, I get reminded not to use it pretty much every time I’m forwarded a press release laden with news about someone’s “solution.” Solution to what? I’ve been seeing that term since I started covering health IT more than a decade ago, and I still don’t see much getting solved in healthcare. With all the “solutions” out there, you’d think that healthcare had been fixed by now.

I could get a whole lot more curmudgeonly on you, but I think I’ll stop now and await your comments.


Meaningful Use Doesn’t Address ‘Hybrid’ Transition Period

Posted on July 7, 2011 I Written By

Some 10 years ago, when I first started covering health IT, a lot of the talk was about the “modular” approach to EMR adoption, i.e., put in a piece at a time during a transition period. Much of that had to do with the state of technology at the tail end of the dot-com bubble, when companies developed applications to address one small problem, often in the hopes of getting a larger firm to shell out big bucks for their idea. (Wouldn’t you know, that’s how many vendors, most notably GE Healthcare, put together end-to-end enterprise systems.)

Implicit in any step-by-step transition to EMRs was the idea that there would be an interim period where providers would have to run dual electronic and paper systems. It’s a notion that’s always been with us, but how many people still think of it?

I got a reminder this afternoon when I spoke to Ken Rubin, Iron Mountain‘s senior VP and GM for healthcare, who was talking about results of a new survey on progress toward meaningful use. (I was ostensibly doing that interview for InformationWeek Healthcare, so look there tomorrow for coverage. Here, I just want to talk about one aspect of the conversation.) Rubin noted that there seems to be a sort of “no-man’s land” between the paper and digital. “I don’t see a real, well-defined way of dealing with the hybrid world,” when hospitals and medical systems are switching to EMRs while still retaining old paper records.

Obviously, Iron Mountain would like to sell some scanning, data management and shredding services to healthcare organizations, but Rubin has a point. The rules for meaningful use Stage 1 don’t say a thing about what you’re supposed to do with existing paper files, and it doesn’t appear that Stage 2 will address that issue either.

Do you scan all the old files immediately, or wait until each patient’s next visit, then chart electronically going forward? What do you do with the files of inactive patients? Do you archive records in house or offsite? Do you still need rows of files taking up valuable square footage that could be put to better use? What do you do with clerical staff?  Do file clerks become managers of electronic health information, or do you need to replace those people with others trained in HIM?

Rubin noted that this limbo often works against organizations trying to overcome physician resistance to change. “The faster you can get to the other side, the faster you’ll get physician adoption,” he said.

That all makes good sense to me. CIOs and practice managers, what do you think? Have you addressed hybrid workflow during this transition period, or is the siren call of federal dollars for meaningful use too strong?


Helping doctors adapt to EMRs

Posted on May 8, 2011 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.

Much ink has been spilled discussing why physicians are resistant to adopting EMRs.

The thing is, it’s really no mystery.  Researchers have arrived at what seem like sensible answers to the question, including a) problems changing their work habits, b) fear of the unknown and c) struggles with kludgy interfaces.

So, why not take these problems on directly? While we can’t get inside clinicians’ heads and tell them how to think, we can address their issues concretely.

If the anecdotes I hear are accurate, many are pushed into EMR use and forced to do all the adapting, rather than getting the help they need.

So how can we help?

Obviously, physicians and other clinical staffers need access to accessible, intelligent training — ideally, both Web-based and live — as well as easy-to-use documentation that’s written in very simple language.

But that’s not all. While many institutions breeze by this step, IT departments (or consultants) should do everything they can to customize the EMR experience for individual clinicians. (If your EMR is too rigid to allow for this, that’s another story, but let’s pray you have one with some flexibility built in.)

It’s also important to pinpoint what other frustrations clinicians may have. For example, some doctors who type poorly are immensely frustrated by using EMRs, something keyboard-savvy techs might never consider.  A good old-fashioned typing course might work wonders in those cases.

In the rush to deal with the complex technical issues involved in EMR integration, it’s easy to blow by the needs of individual users.  It’s even easier to throw some fragmentary training at clinicians and assume they have a bad attitude if it doesn’t “take.”

The truth is, though, that nobody can afford to be short-sighted about getting users connected to EMRs.  Let’s hope everyone bears this in mind as the main wave of rollouts begins.