2010 will be the year of health record implementation

2010 will be the year of health record implementation

Summary: At the end of 2009 we know what the game here is. The game is not to install EHR systems, as was believed at the start of the year. The goal is to gain value from them, ideas we can use to drive down costs and change the system.

TOPICS: Health

In their excellent review of 2009 trends at The Health Care Blog, David Kibbe (below) and Brian Klepper (right) note that key decisions on Electronic Health Records (EHRs) were made this year, making 2010 a big year for implementation.

Both are modest regarding their own roles in this. But they have been key advocates for these changes (or something like them), and have applauded most of them along their way.

  1. Stimulus money will flow based on making use of EHRs, not just for EHR software and hardware.
  2. EHR advocates now face hard questions relating their gear to gains in productivity and quality.
  3. The CCHIT, a product of the HIMSS industry group, no longer has control over the choices hospitals and clinics have.
  4. Power is slowly moving from EHR "experts" like McKesson and Epic toward general technology firms like Microsoft.

Each of these changes are enough work for one year. Together they portend a lot of upheaval for 2010.

Here are just some of the implications:

  1. There is going to be a gold rush. Hospitals and clinics are going to turn from Lookie Lous to serious buyers in 2010.
  2. Expect some big mergers as firms like H-P and Dell seek credibility with this market, buying the best of the mainline firms.
  3. The focus on productivity means we're going to see a lot of "case studies" focused on using EHR data to drive change in medical practice.
  4. There is going to be a lot of job growth throughout the sector.

The National Coordinator for Health IT, David Blumenthal, set us up for the last by putting $80 million into training the EHR shock troops, who should start emerging from community colleges in the next year.

My guess is most of the new graduates will wind up on the "buy" side of the EHR table. They are going to be tasked with making all this stuff work, under the guidance of "sell" side EHR experts trained during the last decade and business school graduates focused on results.

Those results will be driven by the beacon communities on whom Blumenthal's office will bestow $235 million starting early next year. The big news of 2010 will probably be made in February, when the money is doled out and we get to see what the Administration defines as excellence.

And don't forget. This still leaves over $18 billion unaccounted for, money that will start to flow during the year as hospitals and clinics achieve the 2011 "meaningful use" goals.

There are going to be a host of stories flowing out of those beacon community grants. Here is one example.

Will those being honored in February still be on the job in May, or will they quickly be hired away by vendors eager to know "the secret" to getting stimulus cash? That could be disastrous, because the beacon communities won't be getting honored for what they have done, but will be getting incentives to do more.

At the end of 2009 we know what the game is. The game is not to install EHR systems, as was believed at the start of the year. The game is to prove value from them, getting ideas we can use to drive down costs and change the system.

That's what we'll be looking for next year, too.

UPDATE: While I was writing this Microsoft announced it is buying Sentillion, which works at moving EHR data from proprietary systems to the Web. The merger gold rush has already begun!

Topic: Health

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  • Big Money

    OK, again claiming the new IT thing is going to be big money show you know cliches.
    Now in the real world hospitals are having a serious cash flow problem and the issue is worse for independent doctor offices. Let's talk about where big money is being spent.
    EHR's are a mess. A current example: Hospital E and Hospital P, large seperate healthcare systems are trying to share data that is already in digital formats. However, do to equipment brought from different vendors, it is still simple to hand carry the Cardiac Cath DVD between hospitals with the patient, rather than atempt to use the very expensive T3 lines set-up for simple sharing of the cardiac cath film. Labs give me heartburn as what is a "normal value" at E is a critcal value at P, so the norms have to be sent along with the results and after sepnding days explaining to various MD office staffs, adding a large bold print statement This result is from E and see the norms for E printed next to the lab result calmed the staff and saved many patients from repeated lab tests as MD after MD claimed that the value could not be right.
    McKesson in my personal view is the worst vendor to merge info into the EHR. Nursing staff is only half joking about cleaning their guns at work and using McKesson equipment as the target. Four months after delay after delay, Hospital P upgraded to new McKesson medication software because McKesson stopped supporting previous versions. (Finance committee wonks like McKesson because it links better into the McKession supplied billing software.) On zero day, the Chief Nursing Officer, was going around the hospital giving staff hugs and encouraging the staff not to quit. On, I left out the the new software big selling point was better tracking of IVF and not just pills, The problem is that the software refuses to recognize the IVF bar codes and the pharmacy staff has joined the nursing staff about cleaning the guns at work.

    My take home point is that every time you talk about the glories to come from EHR, the troops is the trenchs know you are secure in your Ivory Tower view and paycheck.
    • Two things from the story

      1. The stimulus reduces the cash crunch pressure so hospitals can buy the gear.
      2. The "beacon" program is designed to showcase success stories, examples you can emulate, not only of successful implementation but of change based on using the data.

      It's not all ivory tower. I think the HIMSS approach was ivory tower, and it didn't work, according to a recent Harvard study.

      The approach this time is first, find what works and try to copy it.
    • You're spot on.

      With the money rush in full stream there are giong to be a LOT of
      SNAFUs and FUBARs. One only has to talk to folks in the various
      medical professions to understand that they are going to be lucky when
      things work like they should. Nurses? Lab techs? Pharmacy staff? Yep.

      There simply isn't enough skilled, educated, experienced medical
      professionals to work with companies looking for the money. There
      will be systems that are 85% to 95% effective, but the 5% to 15% is
      going to be a killer.

      How much to I trust the suppliers? I used to design systems for
      retailers so I know not to trust them on things I cannot duplicate.
      That's why I carry copies of everything I can get my hands on in my
      notebook - including images loaded into OsiriX.

      I think one issue that IT companies looking to make a killing on is the
      liabilities that juries are going to be establishing. By getting involved in
      the patient's care these companies are going to be exposed to liabilities
      to problems they create. ANd a blind man running for the bus can see
      that there will be problems and patients suffering damages.
      • There are always problems

        There are problems in any fast-growing market, from personnel shortages to fast-buck artists.

        The NCHIT program is meant to minimize that, by finding what works, and the profitable changes it brings.

        Yes, profitable. You save money and you protect margins.

        Are you arguing against fast-growing markets or higher profit margins? Of course not. You're just skeptical of change when government has a hand in sponsoring it.

        Guess that Internet thing didn't work out for you.
  • You are missing what I said

    If you are going to provide systems in the health care
    environment and those systems can or may impact the
    health of patients in a negative way then you had better
    be ready for lawsuits. And you had better be ready for
    juries that get angry and let you know it.

    I believe that there are some special environments that
    require more than laymen attitudes & experiences.
    Commercial aircraft (building and using) is one - just look
    at what Boeing is going through with the 787 and the
    certification it needs to fly.

    Medicine is obviously another. There would already be
    some standards on medical equipment (MRI systems, lab
    systems, etc.) and I believe that there needs to be some
    standards on management of patient data. There is no
    reason to establish these IT systems as liability free. All
    that means is that lower standards are acceptable.

    I think it is also important to understand that it is not all
    going to happen quickly. I'm on VA health and can order
    prescription refills online. But I can't get copies of various
    lab or imaging reports, or copies of actual images online
    - I have to go to the local VA Clinic. It is giong to take
    time and money to get me to where I have read access to
    all my files. But there is a benefit in my being able to
    access that information and data from anywhere -
    especially an ER.
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