by: Michelle McNickle, Web Content Producer
Discussions surrounding EHRs and their adoption (or lack thereof) have grown into heated debates concerning their usability and effectiveness. And the most vocal folks, whose opinions could very well change the way EMRs work, are none other than the end users themselves: the clinicians.
That’s why we looked to David Hager, MD, to debunk some of the myths and explain some of the gripes he and his colleagues have with EHR systems.
With that said, Hager gives us five points of view from an EHR end user:
1. Just how bad is it? “The nature of our problems propelled a line of thinking that I hope might be useful outside of our own paralyzed system,” said Hager. To him, daily experiences with “clunky interfaces, awkward data entry, mind numbing popups, excessive mouse clicks, nonsensical forced choice radio buttons, slow response times, loculation of information, lack of integration or analysis, and identical looking notes,” is unbearable. “None of this would have inspired me to buy an EHR with my own money,” Hager added. So instead, he developed workarounds with word processor macros, spreadsheets, and .PDF software to do what the EHR can’t and won’t.
[See also: EHR adoption still a top concern for physician practices.]
2. Alternative systems are hard to implement. Hager said his colleagues harbor the same feelings of discontent toward the EHR they’re using. So naturally, Hager began to wonder: Why can’t they find a new EHR? “Cost,” he said. “Yes, there’s the prodigious cost of a new product, but then there’s the problem of migrating existing patient data to the new product. Vendor lock.” If a practice makes a significant capital investment on a go-forward basis in an EHR system, said Hager, but it realizes the decision was a mistake, there’s little they can do about it. “Now their patient records are locked in a bad product, unless the practice is in the enviable financial position of being able to change products,” he said. “It will either muddle unhappily along with the bad product, or dump the records back to paper. The cost of a new EHR plus the cost of data migration equals prohibitive cost.”
3. Physicians are open to new technologies. Believe it or not, Hager said physicians are indeed eager adopters of technology that helps them work faster, more effectively, or more profitably. “Since EHRs weren't meeting those standards, and we weren't buying them, especially at the going total cost of ownership, the government decided the problem was not with the EHR products, but with the doctors,” he said. “And so, [it] enacted a program to carrot/stick us into using them.” Hager pointed out similar programs weren’t necessary for the adoption of CT scanners, PET scans, robotic surgery devices, ambulatory EEGs, gene sequencing, and even smartphones. “So why create a program to force adoption of EHRs?” he questioned. “Because we didn’t like them. They weren’t market ready.”
[See also: EHR alliance to help physicians adopt IT.]
4. Try giving physicians what they actually want. In reality, said Hager, if EHRs offered clinicians what they wanted and needed, they’d be flying off the shelves. “Steve Jobs understood that,” he said. “Provide a product that inspires and moves a customer beyond the mechanics of software and hardware.” Hager looked to a colleague to describe the EHR they’re using. “Our EHR, ‘lacks the level of sophistication and integration necessary to capture my imagination and fuel a desire in my mind to think of ways I can use it to help make my job easier and enrich the lives of my patients.’” In his own experience, Hager added his EHR has failed to work for him. “I work for it,” he said. “I’m a data entry tool that serves the product. It does little for me in return that a paper record can do better and more reliably. It’s recognized within our medical staff that our EHR is not a tool for clinicians – it’s a tool for administrators."
5. Flexibility is key. Despite his gripes concerning EHRs, Hager believes there is a solution that could work and even make EHRs something physicians “actually crave.” “If clinicians can change EHR products at will, with little or no data migration cost, they are likely to try multiple products until they find what they like,” he said. In a scenario such as this, he said, market competition would be fueled by freedom of customer choice, driving vendors to produce what clinicians want at more competitive prices. “How to get there?” Hager asked. “Standardize data constructs. HIE developers want that so HIE will work. Apply the same concept to the main body of patient data, and not only will HIE be seamless, but EHR products can become interchangeable.” Structure the data first, Hager added, and design the products second. “That progression helped to fuel the wild explosion we call the World Wide Web.”
Follow Michelle McNickle on Twitter, @Michelle_writes
By: Paul Barr
Vibra Healthcare, Mechanicsburg, Pa., will transfer operations of its Dallas medical district long-term acute-care hospital to suburban Desoto, Texas, and LifeCare Hospitals of Dallas will relocate its LTAC operations to the Vibra location under the terms of a new dea
LifeCare Hospitals of Dallas, a 64-bed hospital that is part of for-profit LTAC chain LifeCare Hospitals, Plano, Texas, agreed to acquire select assets of 60-bed Vibra Specialty Hospital, Dallas, and will relocate to Vibra's location on Record Crossing Road later this year, according to a LifeCare news release (PDF). "The acquisition of the Vibra assets, our relocation in the medical district and our commitment to expand the capabilities in our new location is a reflection of our commitment to the Dallas area," said Jay Lindsey, CEO of LifeCare Hospitals of Dallas, in the news release.
Meanwhile, for-profit LTAC and rehabilitation chain Vibra announced that it plans to open a new LTAC facility with 40 licensed beds in Desoto, transferring assets from its Dallas operation in the process. "While we have been quite successful working with key referral sources in the Dallas medical district, we recognized it was a solid business opportunity to expand Vibra Healthcare in the rapidly growing market of southern Dallas County," said Vibra founder, Chairman and CEO Brad Hollinger in a news release.
The deal is subject to customary closing conditions and is expected to be complete before the end of the year, according to LifeCare.
By: Brian T. Hrowitz
Developers expect the advanced data analytics of the Watson supercomputer to predict outcomes in health care and education, according to IBM's 2011 Tech Trends Report
IBM's DeveloperWorks subsidiary has released a 2011 Tech Trends report predicting that Watson supercomputer's advanced data analytics capabilities could play a large role in health care, education and government.
DeveloperWorks is Big Blue's online community where IT professionals can develop tech skills in areas such as open source, business analytics, cloud computing and mobility.
Business analytics software will dominate the workflows of many industries, including health care, education, government and financial services, according to the report's results, which IBM announced Nov. 15.
The goal of the report was to provide a guide to the skills needed in IT for the future, according to IBM.
IBM interviewed 4,000 IT professionals from 93 countries and 25 industries about IT trends. The most responses came from Brazil, China, India, Russia and the United States.
Regarding opportunities for Watson, respondents believed education and health care were industries that Watson's advanced data-analytics capabilities could serve best.
"Data analytics will have a profound impact on health care moving forward as it represents an important way to finally make sense of the volume of health care data," Mike Riegel, IBM's vice president of startups, independent software vendors (ISVs) and academic programs, wrote in an email to eWEEK.
Large amounts of data in medical images and electronic health records will drive a need for advanced data analytics, he noted.
"The best way to help doctors is to provide powerful analytics tools that are part of their decision-making processes," Riegel said.
The changing business model toward doctors being paid for health outcomes rather than individual visits could make data-analytic tools important for measuring performance, he added.
"When you look at the overall ranking of industries, those that ranked in the top are all dealing with massive volumes of data that could provide strategic insights," Riegel said.
Business analytics, like that found in Watson, will have a role in predicting outcomes, including successful treatment of patients, Riegel noted.
On Oct. 25, IBM introduced Content and Predictive Analytics for Healthcare, an application that provides content analytics to spot patient health patterns and improve care. Business analytics will also be able to connect medical data to mobile EHRs using natural-language processing and technology similar to Watson.
In education, analytics will help teachers and administrators understand learning trends and lead to better collaboration between students and teachers, according to Riegel.
Meanwhile, in government, analytics can help predict criminal activity and spot crime trends in populations, Riegel said.
Open source will play a huge role in software development, according to 75 percent of respondents. In particular, flexibility in designing cloud-computing infrastructure is important to developers interviewed.
"Now, CIOs can develop, deploy, manage and integrate both traditional and new Web-based cloud applications in minutes rather than weeks with the flexibility and scalability they need," Riegel said.
Mobility and social business software were other top tech trends respondents highlighted.
"The results are clear: Mobile computing, cloud computing, social business and business analytics have gone beyond niche status and are now part of any modern organization's core IT focus," Jim Corgel, IBM's general manager for ISV and developer relations, said in a statement. "IT professionals who can develop the skills needed to work across these technologies will be ready to meet growing business demand in the coming years."
By: Steve Campbell
The Centers for Medicare & Medicaid Services (CMS)
that six more states have launched programs to register providers for Medicaid electronic health-record incentive payments under the American Recovery and Reinvestment Act of 2009. This brings the total number of active states to 39, and the total number of states making payments under the program to 23.
The six new states are:
- New Jersey
- New York
- North Dakota
There are 11 states that have yet to launch their programs. Those states are: Colorado, Hawaii, Idaho, Kansas, Minnesota, Nebraska, Nevada, New Hampshire, South Dakota, Virginia and Wyoming.
By: Alex Knapp, Forbes Staff
Just one week after Fujitsu announced that it had developed a supercomputer for commercial sale, the company has announced its first order. The University of Tokyo has placed an order for a supercomputer, which will comprise 50 racks and 4800 nodes, enabling it to reach a theoretical computing speed of 1.13 petaflops.
When the supercomputer is installed at the University in April of 2012, its speed will likely make it one of the top 20 faster supercomputers in the world. In last year’s Top 500 supercomputer list, fewer than 20 of supercomputers broke the 1 petaflop barrier.
The new system is expected to be put to use for a variety of applications including astrophysics, seismology, environmental modeling, materials science, fluid dynamics, and solid mechanics. Corporations are expected to make use of the supercomputer’s capabilities, as well.
By: Michelle McNickle, Web Content Producer
New Health IT was anywhere and everywhere in 2011, promising ways to streamline data and increase patient care. Now, with even more technology on the cusp of the mainstream market, it’s only natural to wonder what’s the best.
That’s why we asked Ahmed Ghouri, MD, co-founder and CMO of Anvita Health, what he believes were the most influential new technologies within the past year and what will be game changers in the years to come. “If you look at the stages of healthcare we’re going through, the first is structural, which includes CPOE, EMRs, and health information exchanges," said Ghouri. “So data management in storage, and data exchange. I think once we solve the structural problems, it will be like creating a Web browser; dramatic value is created once everyone is on the Internet. It’s not just getting online, but also doing things with the data online.”
Ghouri believes we’re making progress in the structural aspects of healthcare, and the most innovative health IT isn’t in the area of data gathering but rather data interpretation. “I would say they’re the most important things in terms of their long-term significance,” he said. “But we’re still early in their widespread adoption.”
Check out Ghouri’s round up of the best health IT innovations within the past year:
1. Noise reduction of patient data. Ghouri said noise reduction of patient data is the foundation for clinical decision-making and is also essential in understanding what’s real and what’s not. “Especially in mixed-mode environments,” he added. “Imagine you have patient data coming in through multiple sources. There can be different sets of medical conditions, diagnoses, etc., which can result in conflicting things. There may be things about [the patient] that may not be true today. So being able to create an active problem list of high veracity data on a patient is a significant innovation.” Ghouri also cited medication reconciliation as a problem. “And I would extend that to problem list reconciliation,” he said. “If you combine the two, we refer to that internally as a smart problem list for that patient. Having data coming from so many sources, it’s hard to tell what’s real and what’s not. So, it’s essentially EMR information reconciliation.”
2. Real time analytics. According to Ghouri, real time analytics, as opposed to batch mode analytics, allow decisions to be made immediately. “This is important because physicians and caregivers, for the most part, don’t have the time for interpretation of patient data,” he said. “They need to make a decision within minutes. So being able to analyze patient information in real time is important.” Ghouri added that a lot of the data exchange that’s occurring through the use of EMRs and CPOE may be assembled just in time, meaning there’s no existing database of a comprehensive view of the patient. “If someone wants to interpret data assembled 20 seconds ago, for example, you have to have real time analytics.”
[See also: 2011: Gazing into the crystal ball.]
3. Variable benefit design. Looking ahead, Ghouri noted there will be differential payments for clinical outcomes, rather than just volume of care. This includes payment based on quality and for keeping patients out of the hospitals. “And there are penalties for hospital readmissions,” he said. “So variable benefits design allows for payments for clinical outcomes rather than the volumes of procedures that were done on patients.” Variable benefit design requires technological capabilities, said Ghouri, and it can’t be done with just policy. “You need to be able to adjust copays or payments based on clinical outcomes.” Ghouri said his company recently received a patent on variable copays of medication using patient data, which he believes will be significant in the years to come. “Imagine a doctor is about to prescribe a therapy in an EMR, and let’s suppose that medication was potentially lethal to the patient,” he said. “You can dynamically adjust the price to preclude its use. It’s context-specific pricing. We’re very early in terms of its widespread adoption, but putting a milestone marker in the road, I would say that’s the most significant of the year.”
[See also: New IT buzzwords: 'medical identity theft'.]
4. Comparative efficacy of treatments. Ghouri cited comparative efficacy of treatments as a significant innovation not only within the past year, but also in the years to come -- specifically, mining electronic patient data to understand treatment options. “For example, with the 200 different treatment protocols for breast cancer, it can be difficult to decide which one enables patients to live the longest and which ones aren’t successful,” he said. “Using actual data helps because there isn’t time to do clinical trials on every option. But, if you have huge data sets, you can use empirical trials or pragmatic clinical trials to compare treatments head to head, virtually on a continuous basis, once you have data organized.”
From: EMR & EHR News
Now all Cisco healthcare customers, from single-practice physicain offices to large Integrated Delivery Networks, can take full advantage of EXTENSION's advanced clinical alerting solutions integrated with Cisco's powerful and robust Unified Communications platform.
EXTENSION is the only vendor of its kind that integrates with Cisco’s entire panel of call processing systems including Cisco’s UC500 for smaller healthcare organizations, CME for medium-sized facilities, and CUCM for enterprise hospital systems. EXTENSION’s server-based clinical alerting and communication platform can scale to any size healthcare facility. EXTENSION enabling all versions of Cisco’s Communication Manager solutions allows hospital systems, large and small, to utilize one alerting middleware platform to meet all of their integrated delivery needs including outlying physician office workflows and alerting, off-site lab and radiology office workflows, and much more. The EXTENSION solution can be hosted remotely using virtualization software or at each location regardless of which Cisco solution is being utilized.
According to Todd Plesko, CEO of EXTENSION, “Because we support all of Cisco’s Communication Manager products we can offer Cisco clients the ability to have alerting and messaging married with all of their facilities, including those not in the hospitals such as ancillary lab and radiology offices, as well as ambulatory physician offices. This is very important as the trend is more and more hospital systems owning the full continuum of care in a community including these off-site services. Our solutions match that trend and allow a hospital system the flexibility to have one alerting and messaging solution to match all of their Cisco communication systems, large and small, in any environment. It keeps it easy for hospitals system as they grow, acquire more facilities, and wish to expand their Cisco Unified Communications systems. EXTENSION is a fit for any size Cisco healthcare client.”
EXTENSION will continually develop solutions that integrate with Cisco technologies in order to provide our joint customers with the most advanced clinical communication tools. To date, EXTENSION clinical alerts and notifications can be delivered to Cisco’s 7900 series IP handsets, desktop phones, Cisco Contact Center, as well as the Cius tablet. Additionally, EXTENSION marries Cisco’s VOIP phones to smartphones by allowing HIPAA-compliant text-based messages to be sent to and from the devices. Instant and secure messaging of this nature improves staff satisfaction and advances the delivery of patient care.