Monday, June 02, 2014

In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red

At my Nov. 9, 2013 post "We’ve resolved 6,036 issues and have 3,517 open issues" (http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html) I wrote about "issues" (i.e., "glitches" including potentially injurious or deadly bugs and malfunctions) the organization was having with a new EHR at University of Arizona Health System.

Now we know part of the cost of resolving those 9,553 "issues."

http://azstarnet.com/news/science/health-med-fit/tucson-area-s-largest-area-network-racks-up-nearly-million/article_44d05d04-0acf-5fbc-8561-68d4bef3b577.html
Tucson area's largest health network racks up nearly $30 million in losses
June 01, 2014  • 

Southern Arizona’s largest health network is $28.5 million in the red so far this fiscal year, and officials say a costly electronic medical records system is largely to blame.

The operating loss is unprecedented for the four-year-old University of Arizona Health Network, which includes two local hospitals.

Stellar management was clearly responsible for this wonderful outcome.  When will the layoffs start, I ask? That's the usual managerial solution for financial losses, and in this case I feel particularly worried about employees who did not obey the "suggestion" to only use "Words that Work" about this EHR (see http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html).

The electronic records system, from Wisconsin-based Epic Systems, has cost an estimated $115 million, including $32 million in unbudgeted costs for the first eight months of the fiscal year, which ends June 30, financial documents show. The extra costs are due primarily to a delay in getting the system live and funding additional training and support, officials said. It was supposed to be up and running by Sept. 1, but wasn’t operational until Nov. 1.

$32 million to fix 9,553 "issues", most likely due to implementation incompetence, plus some that perhaps the seller should have at least been partially responsible for...such as these:

  • Pharmacy Medication Mapping Errors
  • Microbiology Results Mapping Incorrectly 
  • Prescription printing bugs
  • Errors transmitting prescriptions

I note that real, live patients were the unwitting experimental subjects in this little software debugging project.

I also note that $115 million could have paid for an entire new hospital or wing - and these startup costs are just the beginning...

... There are other reasons for the network’s weak finances. UA Health Network officials say uninsured patients aren’t getting health insurance coverage through the federal Affordable Care Act as quickly as they’d anticipated, resulting in $11 million less than expected in patient revenue through February.

The network also lost federal dollars from a program that helped bridge the funding gap created by Medicaid rate cuts and a rise in uninsured patients. The Safety Net Care Pool, which also included Maricopa Integrated Health System and Phoenix Children’s, pumped $33 million into the UA hospitals for the first six months of the fiscal year. But that infusion ended Dec. 31 to coincide with greater health insurance availability through the Affordable Care Act.

It's not like these events were entirely unpredictable.  Perhaps priorities could have been rearranged, rather than dumping millions into a known money pit, the implementation of enterprise clinical information technology?

... “The issue is more about where we are going and what things are in place to change the trajectory,” Lynn said. “It was an especially difficult time financially because of Epic, there was no choice in the matter. That period of time has fortunately passed and now we can do much better.”

There certainly was "choice in the matter."  I also suggest to Mr. Lynn that the "trajectory" might end up being a ballistic one.

... A financial report presented to the network’s board of directors on April 24 says the Epic system’s higher-than-expected expenses this fiscal year were due to “implementation delays, additional training support and planned schedule reductions.” Some of the expenses were originally supposed to be in the prior fiscal year.

The report attributes $6.8 million of the current year’s losses to physicians spending enough time training to use the new system that they couldn’t see as many patients between November and January. Schedules were back to normal as of February.

One wonders just how much increased stress and pressure there is on clinicians with the new system in place.  

... Implementing the new system has hit the network’s finances hard, but over time it should improve patient safety by cutting down on unnecessary testing and medication errors, among other things, officials say. Eventually it is expected to save money because of its added efficiency.

"Should?"  Considering the issues I've outlined at this blog and my Drexel University Healthcare Informatics site (http://cci.drexel.edu/faculty/ssilverstein/cases/), this seems a type of wishful-thinking due diligence performed by those who believe in fairy tales and bargain sales of bridges like the one at latitude 40.7045096 N, longitude 73.99480549999998 W.

Let me make a realistic projection:  No money will be saved, e.g., see the opinions from Wharton at http://hcrenewal.blogspot.com/2009/06/wharton-on-healthcare-it-can-i-go-home.html.  

Another projection:  safety will be adversely affected, e.g., see the ECRI Deep Dive study at http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html, the Top Ten Healthcare Technology Risks for 2014 at http://hcrenewal.blogspot.com/2014/04/in-ecri-institutes-new-2014-top-10.html and the FDA Internal Memo on H-IT Risks at http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html, to name a few sources repeatedly mentioned here.

At the UA Medical Center’s south campus, the Epic system has taken doctors from paper charts and uncoordinated computer records to having all patient information — from angiogram and CT scan results to billing updates — in one place, accessible via iPhone.

Try doing medicine on an iPhone screen area...

“This is the future. We have to have electronic medical records,” said Dr. Kwan S. Lee, a cardiologist who is medical director of the UA Medical Center’s south campus.

"This is the future!!  We just have to do it!!"  Dr. Lee, I admire your exceptionally well-reasoned and thorough budget justification for putting your healthcare system $30 million in the red.  Congratulations!

... Lee cited a recent case where a patient who had been previously treated at Tucson Medical Center came to the UA Medical Center’s emergency room, having an acute heart attack. The standard of care in such cases is opening the artery within 90 minutes. In a rush against the clock, Lee was able to click on the patient’s record from TMC and see the area where the patient had prior surgery.

“The patient had consented to share information from Tucson Medical Center and it helped us immensely,” Lee said. “We would have possibly wasted a lot of time. The patient did very well.”

A far, far less expensive document image management system could have accomplished exactly the same goal.

One con is that the system is “a little overly complicated” because it tries to be all things to all people, he said.  “It was painful ... A lot of us are technophobes,” he said. “But there was no way we could move forward without adopting it.”

"A little overly complicated?"  Gee, I guess that's why physicians at Athens Regional Medical Center revolted as at http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html.  The system was just "a little overly complicated!"

"A lot of us are technophobes?"  How about "A lot of us are not EHR hyper-enthusiasts, but pragmatists?" (http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html).

Chief Information Officer Critchley agreed, saying that with the infrastructure in place, the system will be improved as needed over time.


“For better or worse, only when it’s live are you going to get the doctors and staff to engage and do the fine tuning of what it really means, and what they want to see happen,” Critchley said.

This is a political statement at best.  The assumption here is that this technology itself is some sort of miracle worker, just needing "fine tuning" to reveal its miracles.  In fact, most medical inefficiencies and dangers have nothing to do with documentation at all (e.g., see "Is healthcare IT a solution to the wrong problem?" at http://hcrenewal.blogspot.com/2010/12/is-healthcare-it-solution-to-wrong.html).

The only miracle so far has been to put the system $30 million in the red, with more to follow.

... The UA Health Network, which began its Epic implementation in 2012, receives a little over $1 million per year in incentive payments, Critchley said.

That's nice.   They spent $115 million to qualify for a $1 million annual incentive?  Makes perfect sense to me ...

Adoption of electronic records is voluntary, but hospitals that don’t make the switch by October face Medicare payment cuts of about 1 percent, and increasing reductions each year.

At least one reporter reports this factoid accurately.  Hospital and industry execs are fond of misstatements that "EHRs are mandatory."

Critchley has worked on at least four other Epic installations around the country as part of his consulting work and says the UA Medical Center’s has been the least expensive, with the most aggressive timeline. He has worked on projects that cost more than a half billion dollars.

"Least expensive?"  "Half a billion dollars?"  It sounds like first class care for every underserved person in the United States could have been paid for instead of dumping the money into an unproven, experimental computer technology...

At Tucson Medical Center, a $31 million upgrade to its electronic medical records system — also the Epic system — began to reduce expenses [overall net expenses, or just on a limited per-account, cherry-picked basis?  I suspect the latter - ed.] almost immediately after it went live in 2010. TMC is among 3 percent of hospitals nationwide at the highest stage of electronic records adoption, based on an electronic records ranking system.

“We started to see efficiencies the first day,” said Frank Marini, TMC’s chief information officer. Transcription expenditures dropped by half, as doctors who had previously dictated patient notes instead documented them directly into the electronic record, he said.

And they had to type and/or manually edit the results of Dragon or some other VR software.  That's wonderful!  Save money by firing transcriptionists and making the physicians spend their valuable time and attention on clerical work.  Fine business!

TMC began its push to upgrade its partial electronic records system in 2009. The hospital’s early investments in infrastructure, starting in 2002, lowered the cost of adopting a comprehensive system, he said.

Thus, in fact, overall expense was probably several times the $115 million quoted.  Say, perhaps, half a billion dollars?

To any U. Az healthcare employee reading this - remember, if you are experiencing EHR difficulties, only use Words that Work!

2 comments:

Anonymous said...

Betwen the VA delays in giving medical care, in part, due to slowed work flow from EHR and the UA matters above, all in the Phoenix, I believe that the deaths so associated may be substantial.

But when all else fails, rely on the magic of Words that Work, and the magic of secret wait lists.

Steve Lucas said...

At this link from 1 boring old man:

http://1boringoldman.com/index.php/2014/06/02/insels-lament/

We find this quote by Thomas Insel Director of the NIMH:

“And electronic records may become as essential to psychotherapy as the rest of medicine for ensuring that treatments meet established standards and are reimbursed.”

This post by Dr. Nardo shows the thinking of those in leadership positions and the continued push for the use of technology in medicine. My personal belief is that psychiatry is the business model pharma and others wish to use in medicine.

EMR’s are just another tool to increase revenue while ignoring the cost to the medical system. The comments help cement this concept.

Steve Lucas