Electronic Health Records (EHR, EMR)

Four years after what Black Book calls the "replacement frenzy," a recent survey from the market research firm indicates that 87 percent of financially struggling hospitals now regret changing their EHR systems. Among the difficulties the survey highlighted were higher than expected costs, layoffs, declining inpatient revenues, disenfranchised clinicians and doubts over the benefits of switching systems. The survey, which polled 1,204 hospital executives and 2,133 IT staff users, found that 14 percent 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. "It was a risky decision as hospitals were facing the fact that they would not be back to their pre-EHR implementation patient volumes, inpatient or ambulatory, for at least another five years," said Doug Brown, managing partner of Black Book, in a statement. [Also: 'Dissatisfaction' leading to EHR replacement trend] "No other industry spends so much per unit of IT on the part of the business that is shrinking the fastest and holds little growth as did inpatient revenues," he said. Other key findings Black Book gleaned from its survey: 62 percent of non-managerial IT staff says was a significantly negative impact on healthcare delivery directly attributable to the EHR replacement initiative; 90 percent of nurses indicated the EHR process changes diminished their ability to deliver hands-on care at the same effectiveness, yet only 5 percent of hospital leaders indicated EHR replacement had impacted care in a negative way. "In our experience polling, most executives will not admit they were oversold or that their IT decisions had adverse bearing on patient care," Brown noted. Black Book also found that hospital EHR replacements cost jobs, and levels of interoperability decreased. Also, EHR sales people exaggerated the automatic buy-in of physicians and other clinicians, according to Black Book findings.

On Twitter, former National Coordinator for Health IT Farzad Mostashari, MD, called it the "most substantive change to how healthcare is paid for in a couple of decades." The propsed MACRA rule put forth by the U.S. Department of Health and Human Services on Wednesday also holds some pretty big changes for how health IT can be put to work by physicians to drive quality improvement and cost efficiencies. [Also: MACRA proposed rule published by HHS, streamlining federal programs including meaningful use] "By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice and their patients," said Patrick Conway, MD, chief medical officer at the Centers for Medicare & Medicaid Services, in announcing the rule. "Reducing burden and improving how we measure performance supports clinicians in doing what they do best – caring for their patients." So far, most industry reaction to the notice for proposed rulemaking is positive – recognizing the fact CMS seems to have taken the feedback from more than 6,000 frontline healthcare stakeholders to heart, crafting a rule that's attuned to the needs of physicians. In a statement, HIMSS applauded the "significantly streamlined reporting and the acknowledgement process for MIPS-eligible clinicians" in the new rule. "We are encouraged by CMS's effort to coordinate reporting periods across federal programs and the decision to align with the ONC Interoperability and Certification Programs," HIMSS officials said. "With the first MIPS performance full-year reporting period expected to begin on January 1, 2017, we're further analyzing the MACRA rule to ensure that Medicare providers will be able to meet the proposed requirements." American Medical Association President Steven Stack, MD, meanwhile, said it's "hard to overstate the significance of these proposed regulations for patients and physicians." In particular, he was pleased that CMS has been listening to physicians’ concerns and "has made significant improvements, by recasting the EHR meaningful use program and by reducing quality reporting burdens." American Health Information Management Association CEO Lynne Thomas Gordon released a statement saying AHIMA supports the MIPS progam's "emphasis on interoperability, information exchange and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people.'" The Premier healthcare alliance was less pleased, however – specifically taking issue with one part of the two-pronged MACRA approach to value-based care: its provisions related to advanced payment models, or APMs. CMS "made a significant mistake in not including any bundled payment or Track 1 Medicare Shared Savings Program ACOs as qualifying advanced payment models under MACRA," said Blair Childs, senior vice president of public affairs at Premier Inc. "Rather than rejecting bundled payment programs, we believe CMS should focus on ways to alter the bundled payment programs to demonstrate use of certified EHR technology and align measures with other Advanced APMs. "We also believe CMS seriously erred in excluding Track 1 MSSP ACOs in the APMs for failing to meet the more than 'nominal risk' financial requirement," said Childs. "As we've learned through members in our Population Health Management Collaborative, these programs require providers to not only forego revenue through a lower volume of services, but also investment millions of dollars in redesigning care through new technologies, data analytics, additional staff, etc.," he said. "We think most businessmen would call that more than nominal risk, yet CMS choses to define it as only cases where there is risk to the government." Elsewhere in the Twitterverse, the response was mostly positive – with some skepticism and a bit of I-told-you-so mixed in. And "Meaningful Use" is going "away" by changing its name to "Advancing Care Information" #MACRA #livetweeting as I read the proposed rule — Joy Rios (@askjoyrios) April 28, 2016 or basically what #MU should have been from day 1 @Travis_Broome — Harold Smith III (@haroldsmith3rd) April 28, 2016 1/Bottom Line #MACRA NPRM Game changer. Lots of great changes, 100's of thoughtful details and decisions. Biggest blind spot can be fixed — Farzad Mostashari (@Farzad_MD) April 27, 2016 Really good YouTube "whiteboard" connecting the dots of our MACRA announcement. Plain English. No acronyms. Wow. https://t.co/qLHSpYnWRX — Andy Slavitt (@ASlavitt) April 27, 2016 A tree died for this #MACRA #MIPS #Medicare pic.twitter.com/YsiSd3R9Mf — Amanda Narod (@AmandaBinDC) April 28, 2016

Adam Landman, MD, will take the reins as chief information officer at Boston's Brigham and Women's Health Care, effective May 2.

The U.S. Department of Health and Human Services issued a long-awaited proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, on Wednesday, ushering in some big changes for the ways physicians are assessed for quality of care and use of information technology.    

By and large, population health measurement efforts are poorly developed and uncoordinated – and without effective measurement success will remain elusive, says Georgetown's Michael A. Stoto.

Geisinger Health System has enlisted 100,000 people for its genomic study and did so more quickly than expected. Attracting so many volunteers over two years has prompted program executives to raise the bar to 250,000 or more participants.

Denise Hines, executive director of the Georgia Health Information Network announces some exciting professional news on ​HIMSS Radio and highlights the Women in Health IT initiative.

Mariann Yeager, Chief Executive Officer at The Sequoia Project, talks with Justin Barnes on HIMSS Radio about emerging trends at HIMSS16, especially around interoperability.

There are day-to-day blocking and tackling tactics that every healthcare organization should be doing right now to reasonably address the current security threat landscape.

Officials uncovered 'significant risks' and irregularities during rollout, raising concerns about a viable final product, a spokesperson says.