Fresh Tech-Based Concerns Show No Time for Complacency

IT leaders at healthcare providers are under siege. ROI, legacy systems, cloud software, and the EHR wars are a few of their current concerns.

I'm at the annual Health Datapalooza in Washington D.C., where executives from provider organizations are few in number and the vibe is all about payers, app and website developers, patients, physicians, and government regulators feasting on the latest batch of hospital cost data. The event appears to have doubled in size from last year. From this vantage, it's hard to view traditional healthcare providers as anything but under siege. Here are a few concerns bubbling up:

1. When hospitals install fancy hardware such as a da Vinci surgical system, it doesn't look good for the ROI on that system if it isn't getting used. CMS' 2012 batch of hospital payment data may bring to light evidence that surgical procedures that could be done well enough without such gear are deliberately being crowded out by procedures using the magical technology at hand, in order to justify someone's return on investment for purchasing the fancy hardware in the first place. If they are not already doing so, hospitals and payers must deploy oversight systems to make sure that high-tech intervention isn't conducted unnecessarily.

2. At the same time, outdated gear such as infusion pumps will continue to haunt hospitals if those legacy systems prove to be underperforming or unsafe. Last weekend, I attended the Association for the Advancement of Medical Instrumentation conference in Philadelphia and was shocked to learn that many facilities do not have accurate inventories of the gear they do possess. When medical equipment faces a product recall, too many facilities have to scramble or guess if they have such equipment and where it might be. A good real-time location services (RTLS) system will permit such inventories to happen quickly. Consider investing in one if you haven't already.

3. Cloud software is now starting to surpass on-premise software in capabilities. Even Microsoft Office 365 now has features that are not available on classic Microsoft Office. The time will come, sooner rather than later, when health information systems in the cloud will also surpass equivalent on-premise systems. Get ready for it by understanding what the cloud already can do, and ask your classic EHR vendors about their cloud strategy.

4. Having said that, there will continue to be pushback on moving large chunks of healthcare to a virtual infrastructure. At the recent American Telemedicine Association show, for the first time, two large healthcare providers had booths—Intermountain and Mercy. They weren't just touting telemedicine, but a whole new level of virtual care, with remote monitoring services for sale to rural and community hospitals.

Think of it as an extension of the eICU model into medical/surgical, post-ICU, and home healthcare. Back at AAMI, however, Johns Hopkins Medicine was talking about ripping out virtual care in favor of giving nurses the most advanced possible intelligently managed alarm system yet developed—a move many nurses may applaud. As for those remote monitors, Hopkins officials say the trick is getting caregivers to pay attention to someone in a command center far from the bedside. Expect more debate on this topic.

5. Apple yesterday re-created a bit of the push they made with leading universities when the company launched the Macintosh in 1984. The company is working with a select group, led by Mayo Clinic, to wire up Health, its new consumer-focused iPhone app to electronic medical records and connected sensors, sending alerts to doctors based on a set of app parameters. Samsung is doing something similar for the Galaxy phone. Health systems who want to keep on top of this big-business push need to step forward.

6. Any provider out there who believes that a place exists for the open-source VistA electronic health record should get ready to rally to its defense. In the wake of the departure of VA Secretary Eric Shinseki last week, makers of proprietary EHR software are claiming that part of the VA's housecleaning will be a wholesale rip-and-replace of VistA with a proprietary system, based on assertions that VistA is too hard to use, is falling behind the times, and must be at least partly to blame for the VA's current patient scandal.

But I suspect few if any of the VA's present troubles can be laid at the feet of VistA. It is simply being used as a scapegoat. VistA does have its problems, but it has also done a lot of good within and outside of the VA. Even so, a forthcoming massive EHR procurement effort by a combined VA and Department of Defense could mean curtains for VistA.

7. The Epic juggernaut rolls on at large academic medical centers. University of Arkansas recently went live, and University of Michigan goes live at the end of this week. And Partners Healthcare in Boston, which I visited last week, will replace its two home-grown inpatient EHRs with Epic starting next year. Meanwhile, competitor Cerner suffered a black eye last month when doctors at Athens (GA) Regional Medical Center issued a vote of no confidence in CEO James Thaw, which led to Thaw's resignation, followed six days later by the resignation of CIO Gretchen Tegethoff, a member of CHIME's board. A botched Cerner EHR rollout was the apparent culprit for the shakeup. CHIME officials had no comment.

As if healthcare technology and IT executives didn't have enough worries, this is no time for complacency.