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June 24, 2011
Sidebar EPIC Costs Posted on: 2.16.2009 4:40:42 PM Posted by Vince Ciotti We may not need an economic stimulus package for Healthcare IT; one seems


EPIC Costs

Posted on: 2.16.2009 4:40:42 PM Posted by Vince Ciotti

We may not need an economic stimulus package for Healthcare IT; one seems to have already started in Wisconisn:
  1. Kaiser took out a full page ad in USA Today bragging about the $4 Billion (yes, B as in “bankrupt”) they have spent on Epic's EMR so far. The original budget was about $1.8B per new reports several years ago. Keep in mind that Kaiser represents over 200 hospitals, so that's “only” about $20M per hospital…

  2. Sutter announced they were acquiring Epic for five of their largest facilities (like CPMC and Santa Rosa Medical Center, which were running legacy mainframe systems). First quote of costs was about $150M; most recent pegs it at $500M…

  3. Sentara announced they were budgeting over $200M for their half-dozen Virginia hospitals. Bert Reese is an extremely sharp CIO, so I trust his numbers implicitly: this really is what it will cost.

  4. NYU recently announced a cost of $180B for Epic in ambulatory setting only…

Add them up, and we've got quite an economic stimulus package going in healthcare IT already. What else can the government do? Maybe appoint Judy to one of their committees to dream up ways to spend even more!? Or, wake up the other HIS vendors like McKesson, Cerner, Siemens, et al, to start ramping up their prices (if they can fit so many zeros in their price books).


Obama Stimulus Plan: The Audacity of IT

Posted on: 2.17.2009 8:55:21 AM Posted by Suresh Gunasekamn

I have read through my share of summaries, white papers and articles on the now passed stimulus plan.

“Shock and awe” definitely come to mind when you look at the price tag. The question of stimulus aside, the provisions for Health IT are staggering. As I read the Health IT sections of the summary report on the House website, I was left with only one thought: the audacity of IT. In an industry that has a desperate obsession with hyperbole (any EMR implementation is Clinical Transformation), I don't use audacity lightly. Specifically, three aspects of this legislation seem audacious:

  1. Press all the buttons at once

    The amazing part of this legislation is the shear multitude of hopes and dreams that have been funded. It almost seems as though the President listened to a confession of everything that is wrong with our industry or we wish we could do better, and funded it. Everything from developing better IT medical education and extending medical informatics programs, to technology funding for the underserved; from EMR system certification and interoperability standards, to mandates to use systems and funding to help pay for it. The plan does have one overwhelming incentive in the form of Medicare/Medicaid payments, but beyond that, it is a bit of everything.

  2. Pray for the “invisible hand”

    There is a great presumption in this legislation that with the right incentives, we will do the “right thing” (ala Adam Smith). What is unclear is whether this conglomeration of incentives will lead to lasting change or lead organizations to cut corners and take the path to the minimum necessary IT changes to qualify for the incentives. What the industry truly needs is sustainable investment that we can build on over years. The great hope is that many healthcare systems have already begun the pattern of sustainable investment, and that these incentives will help bring the reluctant to the table, and help those at the table to focus on interoperability. The unfortunate reality is that big money often leads to big unintended consequences.

  3. Trust us to figure out the details

    As with any piece of legislation, the technical details are going to be left to the “experts.” This industry has a long history of success and failure on technical standards. I'm not sure that this legislation will make our efforts any better or worse, but there is always the hope that urgency will drive practicality. This legislation requires us to also figure out the details on the fronts of clinical collaboration and privacy protection. We must put forth some standard business practices that the industry accepts in order to meet the goals of this legislation.

(To read the Posting in its entirety, visit


Please Don't Wear a “Members Only” Jacket to an Interview… EVER!

Posted on: 2.15.2009 7:44:57 PM Posted by Tim Tolan

A few months ago, as I was conducting a search for a “C” level executive for a very well known healthcare organization. Let's just say it's a marquee name, okay? The initial interviews were done by phone and then followed up with either a video interview or an in-person interview with each candidate and myself, depending on scheduling. This is done for a variety of reasons, including giving the search consultant a better feel for each candidate being considered. Clearly this was a very prestigious client I was working for. One might assume that any candidate competing for this position with this institution would naturally put his or her best foot forward. Well, maybe not. Are you ready for this? Here we go…

I scheduled the in-person in terview over breakfast to see the other side of this star candidate. Breaking bread with a candidate can tell me a lot! He was prompt and on time. However, Mr. GQ decided to wear a Members Only jacket to the interview so he could display his knowledge of “dress for success.” What? A Members Only jacket? I wanted to say to him - “Are you kidding me? What were you thinking?” Or maybe, “How's that working for you?”

The sad part is that he had great skills and matched most of the job specifications to a tee. Here's the problem: he made the choice to dress casually for a very important interview for a very well known healthcare organization - and a great job. His business acumen led me to believe that he did not give much thought to what he should wear. Come on! His decision making on what to wear really came into question here..

(To read the posting in its entirety, visit


The Stimulus Plan: Calling All EHR Experts!

Posted on: 2.23.2009 4:37:19 PM Posted by Reece Hirsch

The HITECH Act provisions of the federal economic stimulus law expand an individual's right to I receive an accounting of disclosures of protected health information (PHI). As a result, the new law also expands a covered entity's obligations with respect to accounting for disclosures. While the HIPAA Privacy Rule currently excepts from the a ccounting requirement those disclosures of PHI made for purposes of treatment, payment and health care operations, under the HITECH Act, if a covered entity uses or maintains an EHR, this exception does not apply to disclosures of that EHR.

The HITECH Act also provides for a grace period for compliance with these new accounting requirements, including an extended grace period (until January 1, 2014) for those covered entities that began using EHRs prior to January 1, 2009. For those covered entities who acquire an EHR after January 1, 2009, the new accounting requirements apply to disclosures made on or after the later of January 1, 2011 or the date that the covered entity acquired the EHR.

I have two questions for you HIT professionals:

  1. Maintaining an accounting of all disclosures of PHI contained in an EHR sounds very burdensome, if not impractical. What do you think?

  2. Assuming that the EHR accounting requirements are doable, do you think that the time frames provided under the HITECH Act for phasing in these requirements are reasonable?


Social Media 101: Twitter, Part Three: Attracting Healthcare IT Talent

Posted on: 2.6.20091:12:27 AM Posted by Gwen Darling

Well here we are at the end of Twitter Road. In case you've become Twitterpated and don't recall where we've been, let's recap our journey. In Part One, you learned the definition of Social Media, and were introduced to the concept of Twitter, a micro-blogging platform that allows you to share thoughts, ideas - whatever you want - 140 characters at a time. You learned how to set up a personal Twitter account, and, if you did your homework, found at least 25 people to follow. With great anticipation and excitement you then embraced Part Two, where you were given some personal trade secrets about how to find the most desirable fellow Twitterers to follow. Continuing through Part Two on the edge of your seat, you were handsomely rewarded, as you were given a prize list of esteemed Healthcare IT industry colleagues and instructed to observe their Tweets. So here we are at Part Three of our Twitter series, finally ready to remove the training wheels and take the corporate recruiting Twitter account for a spin.

As I've suggested before, it's best if your personal Twitter account stays separate from your professional hospital CIO account. Therefore your first step is to set up a new Twitter account. Because you are able to display your real name in addition to your Twitter name, and in this case you are Twittering in an official capacity, I recommend incorporating the hospital name and your title, if at all possible; for example, “StJohnsCIO” for your Twitter name, and “Bob White” for your profile. This approach helps to extend the reach of your hospital's brand, makes it easier for others to identify your occupation, and allows your successor to assume the Twitter account should you desire to seek greener pastures.

(To read the posting in its entirety, visit


Faulty Arches: The Myth of HIT Adoption

Posted on: 2.9.20091:41:44 PM Posted by Pom Arlotto

In ancient Rome, when the scaffolding was removed from a completed Roman arch, the law read that the Roman engineer who built the arch had to stand beneath it. The point was, if the arch came crashing down, he would experience problems first hand. Millions of dollars have been spent building electronic medical records and laying the ground work for a national health infrastructure. The federal government is preparing to incent HIT “adoption”. Yet, the recent report from the National Research Council's Report - Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions and many articles on the unintended consequences of HIT indicate that we are building more than one faulty arch.

If we step back to examine the goal of “adoption”, what do we mean? For HIMSS Analytics, with the EMR Adoption Model, adoption means the system is turned on and operational within a provider organization. MGMA, the American Academy of Family Practice Physicians, the Commonwealth Fund and many other organizations track diffusion of specific functionalities within the physician community. Yet none of these models track effectiveness, outcomes or benefits of the deployments. Ultimately, our goal should be value not adoption. Once value is realized, adoption will occur.

In our book, “Beyond Return on Investment: Expanding the Value of Healthcare Information Technology” we defined value as technology's impact on the business/clinical performance of the enterprise. In recent years, the industry has assumed that value was a given and assumed a “just do it” mentality. The reality, however, is that value realization must be planned for, managed and measured - and accountability must be assigned.

What is the return on investment to your healthcare enterprise of clinical and business technology during the past three years?

What specific applications in your portfolio are delivering value?

What incremental investments in the short term will take the value of your portfolio to the next level?

Many of the arches built in ancient Rome were not faulty - they are still standing today. To ensure a similar fate, we must shift the discussion away from adoption and toward value realization.

Healthcare Informatics 2009 April;26(4):12-16

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