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Cerner Tops List Of Hospital Vendors For Medicare EHR Incentive Program

Posted on September 28, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Research from the ONC concludes that Cerner systems are in use by the most hospitals using certified technology to participate in the Medicare EHR Incentive Program. It’s interesting to note that this list includes players that rarely appear on overall lists of top hospital EHR vendors, though admittedly, there’s no one way to measure market dominance that produces consistent results every time.

According to ONC statistics, there were 175 vendors supplying certified health IT to 4,474 nonfederal acute-care hospitals participating in the Medicare EHR Incentive Program. Ninety-five percent of these vendors have 2014 certified technology.

The report notes that six of these vendors (Cerner, Meditech, Epic, Evident, Medhost and McKesson) provide 2014 certified technology 92% of hospitals using the technology. When you throw in athenahealth, Prognosis and QuadraMed, bringing the list to 10 vendors, you’ve got a group that supplies 2014 technology to 98% of eligible hospitals.

According to the data, the vendors at the top fall in as follows. Cerner tops the list of total hospitals using its certified health IT, with 1,029 hospitals;  Meditech was next with 953 hospitals; Epic came in third with 869 hospitals; CPSI’s Evident (formerly Healthland) was fourth with 637 hospitals; McKesson fifth with 462 hospitals; and Medhost sixth with 359 hospitals.

As is usually the case with any attempt to look at market share, the data comes with its own quirks. For example, when looking at ONC’s data as of July 2016 on ambulatory healthcare providers choice of certified technology, Epic was way ahead of the pack with 83,674 users. Allscripts came in at a distant second with 33,123 users. Cerner came in sixth with 15,100 ambulatory users. In other words, vendors one might class as “enterprise” focused are doing well among clinicians. (See more data along these lines in a Medscape survey I summarized previously.)

Then consider data from HIMSS Analytics, which concludes that Epic has 40% of the hospital health IT market, followed by Cerner at a distant second with 13%, Allscripts at 10%, Meditech at 7% and eClinicalWorks at 5% and NextGen with 4%. Why the big difference in numbers? It seems that HIMSS Analytics includes the size of the hospital in its calculations versus the ONC data above which talks about the number of hospitals.

No doubt the buying patterns vary when you look at the number of beds a hospital has. For example, according to research done last year by peer60, CPSI and eClinicalWorks held the biggest share of the market among facilities with less than 100 beds, MEDITECH, McKesson and Siemens dominated the mid-sized hospital categories, and as the number of beds rises from 250 to 1000+ plus, Cerner and Epic emerge as the top players.

The truth is, market share numbers are interesting, and not just to the vendors who hope to emerge on top. Everyone loves a good horse race, after all. But it’s good to take these numbers with a large dose of context, or they mean very little.

Nurses Have Love-Hate Relationship With EMRs

Posted on September 26, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Data collected by a nursing degree program suggests that nurses have a love-hate relationship with EMRs, one which acknowledges many flaws but also suggests some degree of satisfaction.

The data, which was gathered by Adventist University of Health Sciences RN to BSN Online Program, offers a window into how nurses feel about hospital EMRs. And much of what they feel doesn’t reflect well on hospital EMRs.

For example, the graphic notes that in 2014, 92% of nurses were dissatisfied with EMR they had to use. Eighty-four percent said the EMR disrupted workflow and productivity, and 85% complained of “continually flawed” EMR systems. In other words, not only did they see their EMRs as flawed, they saw it as broken.

And these weren’t just vague expressions of discomfort. Ninety percent of nurses surveyed by the study said that EMR is negatively impacting interactions between nurses and patients, a fairly concerning claim. What’s more, 94% said that EMRs had failed to improve communication between nurses and doctors.

On top of everything else, a large percentage (88%) blamed high-ranking hospital administrators staff for selecting cheap systems. Isn’t it great to hear that EMR rollouts are alienating nurses as well as doctors? Just lovely.

On the other hand, surprisingly, 71% of nurses told a different study that they would not consider going back to paper-based medical records. Also, in other research, 72% agreed that EMRs help to improve patient safety and avoid medication errors, and 73% felt that EMR’s were enabling collaboration with other clinicians inside their organizations.

Looking at this collection of data, a few things stand out:

  • Generally speaking, nurses seem more comfortable with EMRs than physicians, more of whom seem to feel that EMR systems create obstacles to providing good care. But they’re frustrated nonetheless.
  • Too many nurses seem concerned that their EMR is glitchy technically. This should worry hospital administrators, because even if this perception is false, it’s a real problem if nurses believe that they can’t provide adequate care using the system.
  • Given that more than two-thirds of nurses responding to one study wouldn’t go back to paper, clearly some hospitals are doing things right (or at least paper was even worse than EHR).

Of course, nurses don’t develop ideas about EMRs in a vacuum. Hospitals can do a great deal to help nurses become comfortable with their new or upgraded EMR, such as enlisting the support of the chief nursing officer in any rollouts that take place and appointing nurses as EMR champions along with physicians. Not to mention ensuring appropriate training even after go-live.

Also, hospitals can do much to set appropriate expectations for EMR use. For example, I’d wager that few hospital IT leaders see EMRs as a particularly apt tool for supporting collaboration (though they might hope that it becomes so in the future). Being clear to nurses as to what they can realistically expect to do with an EMR — and what future features might be — makes it more likely that they’ll appreciate what the system can actually do. Like anybody else, if a nurse knows what they’re getting into with an EMR system, they are more likely to be on board.

Meaningful Use Has Done Its Job

Posted on September 19, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While Meaningful Use has been challenging at times, the vast majority of hospitals seem to have stayed on top of things. In its new report on the IPPS negative payment adjustments for fiscal 2017, CMS said that 98% of eligible hospitals and critical access hospitals managed to avoid Medicare payment dialbacks for next year, because they successfully attested to stage 1 or stage 2 Meaningful Use compliance, according to EHR Intelligence.

CMS began making Medicare payment adjustments on October 1, 2014 for eligible hospitals, of which there are more than 4,800 in the United States. The current adjustment will fall into place on October 1, 2016, as a reduction in the percentage increase to the Inpatient Perspective Payment System.

The negative payment adjustments to the IPPS now stand at 75%, up from 25% for the 2013 reporting period. Eligible hospitals had a chance to apply for hardship exceptions to the payment adjustments, though if they haven’t done so already it’s too late, as the window for seeking those exceptions for 2017 closed in April of this year. But as noted, few hospitals will be affected.

At this point, it’s worth taking time to stop and admire how this took place. Even when you consider that the feds handed lot a lot of money in incentives, this has all happened relatively quickly as IT investments go. Everyone likes to talk about how successful the banking industry was at rolling out interoperability with ATMs, but I doubt the backroom negotiations went any faster than the cascade of Meaningful Use attestations. In other words, Meaningful Use did its job.

After all, very few programs achieve close to 100% compliance under any circumstances. Even if providers face large government fines, no initiative is going to get 100% of the industry on board. So bringing 98% of eligible hospitals on board within a few scant years is an impressive achievement, particularly considering the healthcare industry’s record of foot dragging when it comes to new technologies.

Of course, the industry has clearly gone well beyond the need for Meaningful Use’s rather mechanical reporting requirements, valuable though they may have been as a training ground. So if we assume that Meaningful Use isn’t that, well, meaningful anymore, what’s next?

The answer is….drumroll…quality. Most hospitals will be focusing on the larger and more complex quality measurement demands imposed by the next generation of incentive payments proposed by CMS.

As many readers know, the Medicare Meaningful Use program for ambulatory is being rolled into the Merit-Based Incentive Payment System (MIPS), along with the Physician Quality Reporting System and Value-Based Modifier programs. beginning with the 2017 performance year.

Meaningful Use now has a new name in ambulatory care, Advancing Care Information, and strong performance on this measure can contribute up to 25% of the MIPS score a provider receives – or in other words, smart health IT deployment still counts. But that’s dwarfed by the 50% of the score contributed by strong quality performance.

This shift away from IT-specific performance measures is necessary and valuable. But as federal authorities lay out their new incentive programs, it’s worth giving good ol’ Meaningful Use a send-off. A job needed to be done, and however unsubtly, MU did it. We’ll see how quickly the MIPS program rolls over to replace MU in hospitals.

Study: Hospital EMR Rollouts Didn’t Cause Patient Harm

Posted on September 14, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Rolling out a hospital EMR can be very disruptive. The predictable problems that can arise – from the need to cut back on ambulatory patient visits to the staff learning curve to unplanned outages – are bad enough. And of course, when the implementation hits a major snag, things can get much worse.

Just to pull one name out of a hat, consider the experience of the Vancouver Island Health Authority in British Columbia, Canada. One of the hospitals managed by the Authority, which is embroiled in a $174 million Cerner implementation, had to move physicians in its emergency department back to pen and paper in July. Physicians had complained that the system was changing medication orders and physician instructions.

But fortunately, this experience is definitely the exception rather than the rule, according to a study appearing in The BMJ. In fact, such rollouts typically don’t cause adverse events or needless deaths, nor do they seem to boost hospital readmissions, according to the journal.

The study, which was led by a research team from Harvard, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, looked at the association between EHR implementation and short-term inpatient mortality, adverse safety events or readmissions among Medicare enrollees getting care at 17 U.S. hospitals. The hospitals selected for the study had rolled out or replaced their EHRs in a “big bang”-style, single-day go-live in 2011 and 2012.

To get a sense of how selected hospitals performed, the team studied patients admitted to the studied facilities 90 days before and 90 days after EHR implementation. The researchers also gathered similar data from a control group of all admissions during the same period by hospitals in the same referral region. For selected hospitals, they analyzed data on 28,235 patients admitted 90 days before the implementation, and 26,453 admitted 90 days after the EHR cutover. (The control size was 284,632 admissions before and 276,513 after.)

Apparently, researchers were expecting to see patient care problems arise. Their assumption was that in the wake of the go-live, the hospitals would see a short increase in mortality, readmissions and adverse safety events. One of the reasons they expected to see this bump in problems is that some negative problems related to time and season, such as the “weekend effect” and the “July effect,” are well documented in existing research. Surely the big changes engendered by an EHR cutover would have an impact as well, they reasoned.

But that’s not what they found. In fact, the researchers wrote, “there was no evidence of a significant or consistent negative association between EHR implementation and short-term mortality, readmissions, or adverse events.”

I was as surprised as the researchers to learn that EHR rollouts studied didn’t cause patient harm or health instability. Considering the immense impact an EHR can have on clinical workflow, it seems strange to read that no new problems arose. That being said, hospitals in this group may have been doing upgrades – which have to be less challenging than going digital for the first time – and were adopting at a time when some best practices had emerged.

Regardless, given the immense challenges posed by hospital EHR rollouts, it’s good to read about a few that went well.  We all need some good news!

Hospitals Can Learn From Low Outpatient EHR Turnover Rates

Posted on September 2, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

According to new data from HIMSS, almost 80% of freestanding outpatient facilities have an EHR in place, a figure which has shot up 30% over the past five years. This is no big surprise, given that the growth tracks neatly with the Meaningful Use program run. What seems to take HIMSS analysts aback, on the other hand, is that only a scant 15% of outpatient facilities surveyed seem ready to replace or purchase an EHR,

Why are learned minds at HIMSS taken aback by this data? Well, for one thing, hospitals have set their expectations. And over the last couple of years, hospitals have been dumping their existing EHRs at a rapid pace, with many large hospitals switching to newer systems with population health capabilities.

A recent Black Book study suggests that many hospitals weren’t thrilled with the results of even their lastest EHR investment, with some even considering yet another switch. In other words, 2,300 hospital executives and IT staff interviewed weren’t seeing much benefit from their ongoing, massive investment of time and money.

What’s more, HIMSS analysts don’t seem to have taken a close look at how EHR purchasing patterns vary between the inpatient and outpatient setting. And that’s worth doing. After all, if outpatient buyers and inpatient buyers are making strikingly different decisions about how to spend on IT, the reasons for this disparity probably matter.

Important lessons

I don’t have any statistical data to back this up, but I do have a fairly straightforward theory on why hospitals seemingly do worse at investing in EHRs than outpatient facilities. I believe that EHRs are collapsing under the weight of trying to manage entire enterprises.

My sense is that outpatient EHR buyers aren’t just clinging to their existing systems due to inertia or lack of capital (though these factors doubtless come into play). Rather, they’re in a better position to take advantage of the systems they acquire than hospital IT departments.

For most medical groups, their mission is more straightforward and their management structure flatter than that of hospitals, which are having to be all things to all people of late. And this allows them to leverage an EHR more effectively.

To me, this suggests the following takeaways:

  • Hospitals might benefit from an EHR that’s focused more on supporting individual departments/service lines (including outpatient services) than a master enterprise system
  • If EHRs supported individual departments in a modular fashion, and the modules could be switched out between vendors, hospitals could update only the modules they needed to update
  • Hospitals could learn something from how their independent practice partners choose and integrate EHRs

Industry activity clearly suggests that CIOs back a more modular approach to solving clinical problems, and this could help them build a more flexible infrastructure that doesn’t get outmoded as quickly. And if outpatient buying patterns offer additional insights into decentralizing EHRs, it’d be smart to leverage them.

Thoughts On Hospital Telecommunications Infrastructure

Posted on August 31, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Given the prevalence of broadband telecom networks in place today, hospital IT leaders may feel secure – that their networks can handle whatever demands are thrown at them. But given the progress of new health IT initiatives and data use, they still might face bandwidth problems. And as healthcare technical architect Lanny Hart notes in a piece for SearchHealthIT, the networks need to accommodate new security demands as well.

These days, he notes healthcare networks must carry not only more-established data and voice data, but also growing volumes of EMR traffic. Not only that, hospital IT execs need to plan for connected device traffic and patient/visitor access to Wi-Fi, along with protecting the network from increasingly sophisticated data thieves hungry for health data.

So what’s a healthcare CIO to do when thinking about building out hospital telecommunications infrastructure?  Here’s some of Hart’s suggestions:

  • When building your network, keep cybersecurity at the top of your priorities, whether you handle it at the network layer or on applications layered over the network.
  • Use an efficient network topology. At most, create a hub-and-spoke design rather than a daisy chain of linked sub-networks and switches.
  • Avoid establishing a single point of failure for networks. Use two separate runs of fiber or cable from the network’s edge switches to ensure redundancy and increase uptime.
  • Use virtual local area networks for PACS and for separate hospital departments.
  • Segment access to your virtual networks – including your guest Wi-Fi service – allowing only authorized users to access individual networks.
  • Build as much wireless network connectivity into new hospital construction, and blend wireless and wired networks when you upgrade networks in older buildings.
  • When planning network infrastructure, bear in mind that hospital networks can’t be completely wireless yet, because big hardware devices like CT scans and MRIs can’t run off of wireless connections.
  • Bigger hospitals that use real-time location services should factor that traffic in when planning network capacity.

In addition to all of these considerations, I’d argue that hospital network planners need to keep a close eye on changes in network usage that affect where demand is going. For example, consider the ongoing shift from desktop computers to mobile devices use of cellular networks have on network bandwidth requirements.

If physicians and other clinical staffers are using cell connections to roam, they’re probably transferring large files and perhaps using video as well. (Of course, their video use is likely to increase as telemedicine rollouts move ahead.)

If you’re paying for those connections, why not evaluate whether there’s ways you could save by extending Internet connectivity? After all, closing gaps in your wireless network could both improve your clinicians’ mobile experience and help you understand how they work. It never hurts to know where the data is headed!

More Ideas On Tightening Hospital IT Security

Posted on August 29, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Security deserves all of the attention you can spare, and it never hurts to revisit the fundamentals, in part because the cost of lagging security measures is so high. After all, it’s more than likely that your organization will face a breach, as almost 90% of healthcare organizations experienced at least one breach within the past two years, according to a Poneman Institute study done earlier this year.

Here’s some options to consider when tightening up your security operations, courtesy of Healthcare IT Leaders, whose suggestions include the following:

Hire white hat hackers: Mayo Clinic reportedly tried this a few years ago, and learned a great deal. While its security measures seem to have gotten something of a beatdown, the Clinic also found a bunch of security holes and got recommendations on how to close those holes.

Lock down employee mobile devices: As mobile technology increasingly becomes a key part of your infrastructure, it’s important to keep it secured – but that can be tough when employees own the phone. One question to ask is whether your IT could lock or wipe data from employee phones and tablets if need be. What are your legal options for securing critical data on employee-owned devices?

Review medical device security:  Networked medical devices – from respirators and infusion pumps to MRI scanners – increasingly pose security threats, as any device that receives and transmits data can be a target for attackers.  It’s critical to audit these devices, while setting careful security standards for device makers.

Train staff on security issues:  Often, breaches are due to human error, so it’s critical to educate non-IT employees on the basics of security hygiene. Offering basic security training should cover not only cover ways to avoid security breakdowns – such as avoiding generic or default passwords and phishing e-mails — but also explanations of how such breaches affect patients.

Encourage risk reporting:  According to Poneman, almost half of healthcare organizations discovered a breach through an employee within the past two years. What’s more, nearly one-third of data breaches came to light due to patient complaints. It’s smart to encourage these reports, as IT staff can’t have eyes everywhere.

Disable laptop cameras and microphones:  Laptops generally come with a webcam and microphone, but at least in an enterprise setting, it may be better to disable these functions. Why? For one thing, attackers may be able to listen to private conversations through the microphone.

As I see it, the bottom line on all of these activities is to infuse security thinking into as many IT interactions as possible.  It may be trite to talk about a culture of security (it’s easier said than done, and too many organizations make empty promises) but such a culture can actually make a big impact on your security status.

To have the biggest impact, though, that culture has to extend all the way to the C-suite, and unfortunately, that rarely seems to happen. When I read research on how often healthcare organizations underspend on security, it seems pretty clear that many senior execs don’t take this issue as seriously as that should. And if the staggering level of health data breaches happening lately isn’t enough to scare them straight, I don’t know what will.

HHS OIG Says Unplanned Hospital EMR Outages Are Fairly Common

Posted on August 24, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

More than half of U.S. hospitals responding to a new survey reported having unplanned EMR outages, according to a new report issued by the HHS Office of the Inspector General, due to a variety of common but difficult-to-predict technical problems. Some of these outages have merely been inconveniences, but some resulted in patient care problems, the OIG report said.

The agency said that it conducted this study as a follow up to its prior research, which found that both natural disasters and cyberattacks were having a major impact on EMR availability. For example, it noted, hospitals faced substantial health IT availability challenges in the wake of Superstorm Sandy, include damage to HIT systems and problems with access to patient records.

According to the survey, 59% of the hospitals reported having unplanned EMR outages. One-quarter said that the outages created delays in patient care and 15% said that the outage lead to rerouted patient care. Only 1 percent of outages were caused by hacking or breaches.

The most common causes, in order, were topped by hardware malfunctions, followed by Internet connectivity problems, power failures and natural disasters. (For more detail on the root causes of outages, see this great post by my colleague John Lynn.)

It’s worth noting that these hospitals were selected for having their act together to some degree. To conduct the study, researchers spoke with 400 hospitals which were getting Meaningful Use incentive payments for using a certified EMR system in place as of September 2014.

Nearly all of these hospitals reported having a HIPAA-required EMR contingency plan in place. Also, two thirds of the hospitals addressed the four HIPAA requirements reviewed by OIG researchers. Eighty-three percent of surveyed hospitals reported having a data backup plan, 95% had an emergency mode operations mode plan, 95% said they had a disaster recovery plan and 73% said they had testing and revision procedures in place.

Not only that, most of the hospitals contacted by the study were implementing many ONC and NIST-recommended practices for creating EMR contingency plans. Nearly all had implemented practices such as using paper records for backup and putting alternative power sources like generators in place.

Also, most hospitals said that they reviewed their EMR contingency plans regularly to stay current with system or organizational changes, and 88% said they’d reviewed such plans within the previous two years. Most responding hospitals said they regularly trained their staff on EMR outage contingency plans, though just 45% reported training staff through recommended drills on how to address EMR system downtime. And 40% of hospitals that activated contingency plans in the wake of an outage reported that they saw no disruption to patient care or adverse events.

Still, the OIG’s take on this data is that it’s time to better monitor hospitals’ ability to address EMR outages. Now more than ever, the agency would like to see the HHS Office for Civil Rights fully implement a permanent HIPAA compliance program, particularly given the mounting level of cyberattacks endured by the industry. The OIG admitted that HIPAA standards aren’t crafted specifically to address these types of outages, so it’s not clear such monitoring can solve the problem, but the agency would prefer to forge ahead with existing standards given the risks that are emerging.

Hospitals, Groups Come Together To Create Terminology For Interoperability

Posted on August 5, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A health IT trade coalition dedicated to supporting data interoperability has kicked off an effort providing fuel for shareable health IT app development.

The Healthcare Services Platform Consortium, whose members include Intermountain Healthcare, the American Medical Association, Louisiana State University, the Veterans Health Administration and the Regenstrief Institute, is working to increase interoperability by defining open, standards-based specifications for enterprise clinical services and clinical applications.

Its members came together to to create a services-oriented architecture platform that supports a new marketplace for interoperable healthcare applications, according to Healthcare Informatics. Stan Huff, MD, CMIO of Intermountain, has said that he’d like to see more shareable clinical decision support modules developed.

Now, in furtherance of these goals, HSPC members are throwing their support behind an initiative known as SOLOR, which calls for integrating SNOMED CT and Laboratory LOINC, as well as selected components of RxNorm. According to the group, SOLOR will provide a terminology foundation for CIMI (Clinical Information Modeling Initiative) efforts, as well as FHIR profile development.

“We hope SOLOR can serve as a foundation to deliver sharable clinical decision-support capability both within the VA and ultimately throughout the nation’s healthcare system,” said Veterans Health Administration deputy CMIO for strategy and functional design Jonathan Nebeker, M.S., M.D., in a prepared statement.

Ultimately, HSPC hopes to create an “app store” model for plug-and-play healthcare applications. As HSPC envisions it, the app store will support common services and models that vendors can use to shorten software development lifecycles.

Not only that, the evolving standards-oriented architecture will allow multiple providers and other organizations to each deliver different parts of a solution set. This solution set will be designed to address care coordination, gaps in workflow between systems and workflows that cut across acute care, ambulatory care and patient-centered medical home models.

Industry players have already created a small selection of apps built on the SMART technology platform, roughly three dozen to date. The apps, some of which are experimental, include a tool estimating a patient’s cardiac risk, a SMART patient portal, a tool for accessing the Cerner HIE on SMART and an app called RxCheck offering real-time formulary outcomes, adherence data, clinical protocols and predictive analytics for individual patients.

Now, leaders of the HSPC – notably Intermountain’s Huff – would like to scale up the process of interoperable app development substantially. According to Healthcare Informatics, Huff told an audience that while his organization already has 150 such apps, he’d like to see many more. “With the budget we have and other constraints, we’ll never get from 150 to 5,000,” Huff said. “We realized that we needed to change the paradigm.”

Hospitals Using Market-Leading EHR Have Higher HIE Use

Posted on July 29, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study concludes that hospital engagement with HIEs is tied with the level of dominance their EHR vendor has in their marketplace. The study, which appeared in Health Affairs, looked at national data from 2012 and 2013 to look at how vendor dominance related to hospitals’ HIE involvement level. And their analysis suggests that the more market power a given vendor has, the more it may stifle hospitals’ HIE participation.

As researchers note, federal policymakers have expressed concern that some EHR vendors may be hampering the free flow of data between providers, in part by making cross-vendor HIE implementation difficult. To address this concern, the study looked at hospitals’ behavior in differently-structured EHR marketplaces.

Researchers concluded that hospitals using the EHR which dominated their marketplace engaged in an average of 45% more HIE activities than facilities using non-dominant vendors. On the other hand, in markets where the leading vendor was less dominant, controlling 20% of the market, hospitals using the dominant vendor engaged in 59% more HIE activities than hospitals using a different vendor.

Meanwhile, if the dominant EHR vendor controlled 80% of the market, hospitals using the leading vendor engaged in only 25% more HIE activities than those using a different vendor. In other words, high levels of local market dominance by a single vendor seemed to be associated with relatively low levels of HIE involvement.

According to the study’s authors, the data suggests that to promote cross-vendor HIE use, policymakers may need to take local market competition between EHR vendors into consideration. And though they don’t say this directly, they also seem to imply that both high vendor dominance and low vendor dominance can both slow HIE engagement, and that moderate dominance may foster such participation.

While this is interesting stuff, it may be moot. What the study doesn’t address is that the entire HIE model comes with handicaps that go beyond what it takes to integrate disparate EHR systems. Even if two hospital systems in a market are using, say, Cerner systems, how does it benefit them to work on sharing data that will help their rival deliver better care? I’ve heard this question asked by hospital financial types, and while it’s a brutal sentiment, it gets to something important.

Nonetheless, I’d argue that studying the dynamics of how EHR vendors compete is quite worthwhile. When a single vendor dominates a marketplace, it has to have an impact on everyone in that market’s healthcare system, including patients. Understanding just what that impact is makes a great deal of sense.