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Four Things You Should Know About Deloitte’s “Evergreen” EHR Program

Posted on February 20, 2015 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.

Recently, consulting giant Deloitte announced a new program, named “Evergreen,” designed to cut down the cost of implementing and operating hospital EHRs. Unfortunately, much of the Evergreen coverage in the health IT trade press was vague or downright wrong, as it suggested that Deloitte was actually going into the EHR business itself. The key point Deloitte sought to make — that it could implement and operate EHRs for 20% to 30% less than hospitals — did come across, but the rest was a bit jumbled.

Having spoken to Mitch Morris, global healthcare leader for Deloitte Consulting LLP, I can clarify much of what was confusing about the Evergreen announcement and subsequent coverage.  Here’s some key points I took away from my chat with Morris:

  • Evergreen is a suite of services, not a product:  Though some HIT editors seem to have been confused by this, Evergreen isn’t an EHR offering itself.  It’s a set of EHR implementation and operation services provided by Deloitte Consultants. Evergreen also includes a financing scheme allowing hospitals and health systems to obtain a new EHR by making a series of equal payments to Deloitte over five to seven years. (“It’s like leasing a car,” Morris noted.) This allows hospitals to get into the EHR without making an enormous upfront capital investment over the first 18 months.
  • Evergreen is only offered in tandem with an Epic purchase:  The Evergreen program arose from what Deloitte learned after doing a great deal of work with Epic EHRs, including the famous multi-billion install at Kaiser Permanente and an extensive rollout for large hospital system Catholic Health Initiatives. So at the outset, the program is only available to hospitals that want to go with Epic.  Deloitte is considering other EHR vendors for Evergreen partnership but has made no decisions as to which it might add to the program.
  • Both onshore and offshore services are available through Evergreen:  One might assume that Deloitte is offering lower implementation and operation costs by offshoring all of the work.  Not so, Morris says. While Deloitte does offer services based in India and Ireland, it also taps U.S. operations as needed. Clients can go with offshore labor, onshore labor or a mix of services drawing on both.
  • This is a new application services management offering for Deloitte:  While the consulting giant has been managing Oracle and SAP installations for clients for some time, managing EHR platforms is a new part of its business, Morris notes.

According to Morris, Deloitte expects Evergreen customers to include not only health systems and hospitals that want to switch EHRs system-wide, but also those which have done some acquisitions and want to put all of their facilities on the same platform. “It’s expensive for a health system to maintain two or three brands, but they often can’t afford the upfront capital costs of putting every hospital on the same EHR,” he said. “We smooth out the costs so they can just make a payment every month.”

This could certainly be a big score for Epic, which is likely to scoop up more of the EHR-switching systems if Deloitte helps the systems cope with the costs. And Deloitte is likely to get many takers. Let’s see, though, whether it can actually follow through on the savings it promises. That could change the EHR game as we know it.

Is Apple HealthKit Headed For Hospital Dominance?

Posted on February 12, 2015 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.

Even for a company with the cash and reach of Apple, crashing the healthcare party is quite an undertaking.  Not only does healthcare come with unique technical challenges, it’s quite the conservative business, in many cases clinging to old technologies and approaches longer than other data-driven industries.

Of late, however, Apple’s HealthKit has attracted the attention of some high-profile healthcare institutions, such as New Orleans-based Ochsner Medical Center and Stanford Healthcare. All told, a total of fourteen major U.S. hospitals are running trials of HealthKit. What’s more, more than 600 developers are integrating HealthKit tech into their own health and fitness apps.

What’s particularly interesting is that some of these healthcare organizations are integrating Apple’s new patient-facing, iOS HealthKit app with Epic EMRs and the HealthKit enterprise platform.  If this works out, it could vault Apple into a much more lucrative position in the industry, as bringing together health app, platform and EMR accomplishes one of the major steps in leveraging mobile health.

According to MobiHealthNews, the new app allows patients to check out test results, manage prescriptions, set appointments, hold video visits with Stanford doctors, review medical bills — and perhaps most significantly, upload their vital signs remotely and have the data added to their Epic chart. This is a big step forward for hospitals, but even more so for doctors, many of whom have warned that they have no time to manage a separate stream of mobile patient data as part of patient care.

For Apple leaders, the next step will be to roll out the upcoming Apple Watch and integrate it into its expanding Internet of Apple Healthcare Things. CEO Tim Cook is pitching the Apple Watch as a key component in promoting consumer health. While the iPhone gathers data, the smart watch will proactively remind consumers to move. “If I sit for too long, it will actually tap me on the wrist to remind me to get up and move, because a lot of doctors think sitting is the new cancer,” Cook told an audience at an investor conference recently.

All that being said, it’s not as though Apple is marching through healthcare corridor’s unopposed. For example, Samsung is very focused on becoming the mobile healthcare  technology provider of choice. For example, in November, Samsung announced relationships with 24 health IT partners, including Aetna, the Cleveland Clinic and Cigna.

At its second annual developer conference last December, Samsung introduced an array of software tools designed to support the buildout of a digital health ecosystem, including the Samsung Digital Health SDK and Gear S SDK, which lets app makers create software compatible with Samsung’s smart watches. Also, Samsung is already on the second generation of its Simband reference design for wearable device design, as well as the cloud-based Samsung Architecture for Multimodal Interactions, which collects sensor data.

And Microsoft, of course, is not going to sit and watch idly as a multibillion-dollar market goes to competitors. For example, late last year the tech giant launched a fitness tracking wristband and mobile health app. It’s also kicked off a HealthKit-like platform, imaginatively dubbed Microsoft Health, which among other things, allows fitness band users to store data and transfer it to the Microsoft Health app. Microsoft isn’t winning the PR war as of yet — Apple still has a gift for doing that — but have no doubt that it’s lurking in the swamps like an alligator, ready to close its powerful jaws on the next right opportunity to expand its healthcare presence.

Bottom line, Apple has captured some big-name pilot testers for its HealthKit platform and related products, but the game is just beginning. Having users in place is a good start, but Apple is miles away from being able to declare itself the leader in the emerging hospital mobile health market.

BIDMC’s Internal EHR and A Possible Epic Future

Posted on February 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the surprising reactions for me in the announcement of Athenahealth’s acquisition of Beth Israel Deaconess Medical Center’s (BIDMC) in house webOMR platform was by John Halamka. As I mention in the linked article, it really isn’t a pure software acquisition as much as it is Athenahealth going to school to learn about the inpatient EHR space. However, John Halamka’s reaction to this announcement is really interesting.

As I read through all of the coverage of the announcement, John Halamka seems to have shifted gears from their current in house EHR approach to now considering a switch to some other external EHR vendor. This is very interesting given this blog post by John Halamka back in 2013. Here’s an excerpt from it:

Beth Israel Deaconess builds and buys systems. I continue to believe that clinicians building core components of EHRs for clinicians using a cloud-hosted, thin client, mobile friendly, highly interoperable approach offers lower cost, faster innovation, and strategic advantage to BIDMC. We may be the last shop in healthcare building our own software and it’s one of those unique aspects of our culture that makes BIDMC so appealing.

The next few years will be interesting to watch. Will a competitor to Epic emerge with agile, cloud hosted, thin client features such as Athenahealth? Will Epic’s total cost of ownership become an issue for struggling hospitals? Will the fact that Epic uses Visual Basic and has been slow to adopt mobile and web-based approaches provide to be a liability?

Or alternatively, will BIDMC and Children’s hospital be the last academic medical centers in Eastern Massachusetts that have not replaced their entire application suite with Epic?

Based on John Halamka’s comments it seems that his belief might have changed or at least he’s considering the option that an in house system is not the right approach moving forward. No doubt Athenahealth is hoping that they’ll delay the decision a few years so they have a chance to compete for BIDMC’s business.

If you look at the rest of the blog post linked above, Halamka was making the case for Epic back in 2013. I think that clearly makes Epic the front runner for the BIDMC business at least from Halamka’s perspective. We’ll see how that plays out over time.

It seems like we’re nearing the end of the in house EHR hospital. Are there any others that still remain?

Over-hyped and Under-Delivered Tech According to Hospital CIOs

Posted on March 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This is an interesting list:
#BigData
#EHR
#Cloud
#GoogleGlass
#ACO

When you think about the future of health IT, all of these except for Google Glass are guaranteed to be a major role in health IT. The use of data in healthcare is not going anywhere. EHRs will be the foundation of health IT for a long time to come. The move to cloud computing is happening everywhere in healthcare. ACOs are heading are way and I see nothing that will do anything to stop them. Google glass is the only thing on the list that might fizzle, but what Google glass represents (always on, always connected computing) won’t go anywhere.

Does health IT have a PR image issue?

Google Says That Its Cloud Platform Will Sign a Business Associate Agreement

Posted on February 13, 2014 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.

Hey healthcare developers: here’s some news that might interest you. Google has announced that its cloud platform will now be HIPAA compliant and will support business associate agreement going forward, according to Healthcare IT News.

This is not Google’s first move into HIPAA compliance, HIN notes. Google started striking business associate agreements back in 2013, when the HIPAA Final Omnibus Rule went into effect, which made business associates accountable for violating certain HIPAA privacy and security rules.

Now, Google is announcing support for business agreements for its customers. Customers who are subject to HIPAA regulations on the Google cloud platform can count on HIPAA compliance by Google.

This is a smart move by Google, which is poised to snap up big revenues from healthcare cloud activity. According to one research report, global market for cloud computing in healthcare hit $4 billion by the end of 2013, and it seems extremely likely that this number will grow dramatically in coming years.

Google is taking other steps into the health care scene as well. For example, it recently introduced Google Helpouts, a tool for videoconferencing which requires a business associate agreement, which includes supporting telemedicine services.

Greenway, Epic Systems Linked Together

Posted on July 15, 2013 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.

These days, it doesn’t take a lot of data interoperability to make news.  The following, while a perfectly fine effort, concerns just one practice and one hospital, something which reminds us forcefully of how far we have to go. That being said, the details are worth a look.

Lancaster General Health’s Women & Babies Hospital, which runs an Epic EMR, has connected the Epic system with the Greenway EMR at obstetrics and gynecology practice May-Grant Associates. The two entities can now exchange continuity of care documents and securely share patient data, according to an article in Healthcare IT News.

According to Greenway, which issued a press release touting the development milestone, the architecture of its PrimeSUITE platform simplifies data exchange between disparate EMR systems, using a bidirectional, hub-based exchange built to support industry standards.  To connect the medical practice with the hospital, Epic needed to create a connection to the Greenway EMR which would enable data flow between the two entities.

The new interoperability between systems is expected to help coordinate care for more than 2,500 patients with the ob/gyn practice whose babies are delivered at the women’s hospital, Healthcare IT News reports.

Moreover, May-Grant expects shared data access to deliver financial benefits. According to the release, since the systems were connected May-Grant has seen improved practice management and revenue cycle management processes, especially when hospital patients are assigned to the practice for follow-up care.

“Now we’re able to get all of the details we need to process claims on behalf of those new patients,” said Mona S. Engle, RN, May·Grant practice administrator. “Since we can query the hospital for the information we need to submit with a claim, searching for that information no longer slows us down.”

As Healthcare IT News points out, Greenway is part of the new CommonWell interoperability alliance announced at HIMSS13 a few  months ago, but Epic is not.  So far, CommonWell members haven’t come out with any specific interoperability proposals of their own, so that probably didn’t matter this time around.

But it’s worth wondering whether CommonWell membership will make a difference going forward — and whether Epic’s non-participation will undercut hospitals’ ability to pull off projects like these. So far, the benefits of the Alliance seem distant and vague at best.

Survey: Confusion Slowing Meaningful Use Compliance

Posted on May 3, 2013 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 is likely to spur improvements in health IT, confusion over regulations — and the need to pursue other pressing HIT projects — are slowing down MU compliance, according to a new study.

The survey was conducted by Stoltenberg Consulting, which spoke with health IT managers, clinicians, HIT vendors and government agencies that attended this year’s HIMSS event.

Researchers asked which areas in which HIT will achieve the biggest improvements over the next 12 months.  The biggest group (35 percent) named Meaningful Use, while 19 percent said health information exchange, clinical integration and mobile health were due for the most growth.

When asked what might hold them back from meeting Meaningful Use requirements, 29 percent said confusion and/or ambiguity in the regulations were a challenge. Others named competing health IT projects (23 percent) and a lack of key resources such as funding, IT skills, talent and time (17 percent).

The survey also asked respondents what issues were likely to dominate HIT discussions this year.  Respondents favored health information exchange (62 percent), followed closely by mobile health (58 percent) and clinical analytics (54 percent).

As part of the survey, Stoltenberg also asked survey respondents which problems HIT executives would most likely attempt to solve with the help of a specialized IT consulting firm. The responses included ICD-10 (25 percent), Meaningful Use (25 percent), clinical and business intelligence (23 percent), cloud computing (21 percent) and CPOE/clinical systems implementation (20 percent).

Technologies Hospital Leaders Should Watch

Posted on March 29, 2013 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.

Courtesy of non-profit research house the ECRI Institute, here’s some of technologies that they believe hospital C-suite execs should be watching this year. This list was generated by ECRI’s in-house analysts, reports HealthLeaders. Not all of these are directly related to EMR/EHR technology, but we’ve included a few that might be of interest on the broader HIT level.

* Electronic Health Records: This is so obvious it hardly bears mentioning, but yes, EHRs are number one on the list. ECRI notes that execs should beware of possible patient harm in the effort to achieve Meaningful Use, as some HIT-related errors are emerging that can lead to serious care issues.

mHealth:  Mobile applications are becoming an increasingly commonplace part of health IT infrastructure, but managing them effectively isn’t as simple as download-install-use.  This is likely to be the year hospitals need to get it right.

Alarm Integration Technology:  Alarm fatigue has been and continues to be a major issue for clinicians, with some critical care docs experiencing 350 alarms  per patient per day.  Increasingly, alarm integration systems are being implemented which send alerts to phones or pages, leading to more controllable alerts and quieter environments.

Imaging and Surgery:  ORs are increasingly hosting full-scale angiography systems to help guide high-risk minimally invasive surgery, as well as guiding combined open and minimally invasive surgery and verifying successful surgical completion. These hybrid ORs are expensive but have arguably improved results.

* PET/MR:  The PET/MR scanner is beginning to emerge as a new mainstay in oncology, improving on the results delivered for years by the hybrid PET/CR. The PET/MR offers greater detail, helping physicians detect cancers and tumors.

I would have expected to see something on the data analytics technology front to appear this year, but it was absent from the list. I might also have expected to see cloud solutions turn up, but again, not this year.  What technologies would you add to this list?

Remote Patient Monitoring Going Mainstream

Posted on January 31, 2013 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.

This week I read a piece of news which suggests to me that we’re seeing a turning point in the use of remote monitoring technology to manage patients.  It looks like AT&T is taking a major public position in support of remote monitoring via the cloud, via a partnership with a  hot new startup that just raised funding, according to a report in mobihealthews.

According to the mobile health news publication, cloud-based patient monitoring company Intuitive Health just got a $3.4 million investment in what appears to be the company’s first public round of investment.

Intuitive, which completed a pilot with health system Texas Health Resources and AT&T last year, offers cloud-based remote monitoring software which can interface with any device.

The pilot involved monitoring CHF patients remotely for 90 days using wireless pulse oximeters, blood pressure cuffs and weight scales, plus tablets and apps feeding the data to the  patients’ EMR records. During the pilot, THR reduced hospital readmissions for chronic heart failure patients by 27 percent, mobihealthnews reports.

According to a press release from AT&T, Intuitive’s software has since become a key component in the telecom giant’s own SaaS patient monitoring product.

Remote monitoring has been a hot topic of discussion and an emerging approach for several years, but hasn’t found an established place in day-to-day care for most institutions.  With AT&T and Intuitive offering a device-agnostic model, however, I believe they will give a boost to the use of remote monitoring generally.

Personally, I’ve been cheering for remote monitoring to succeed for some time; after all, given how mobile-device-oriented people are anyway, it just makes sense to leverage those capabilities to improve their health.  I hope this represents a turning point for this type of technology and that we see news of more successful pilots this year.

AthenaHealth Grabs Mobile Footprint With Agreement To Acquire Epocrates

Posted on January 8, 2013 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.

Practice management and EMR vendor athenahealth has signed a definitive agreement to buy mobile health information giant Epocrates Inc., in a move which emphasizes the importance of mobile channels to the the future of EMRs.

athenahealth has agreed to pay $11.75 per share for Epocrates, a hugely popular mobile point-of -care app which is very broadly adopted across the U .S. physician base.

The EMR vendor must have really wanted Epocrates badly; the deal, which values Epocrates at $293 million, represents a 22 percent premium over the closing price per share on Friday, January 4, 2013.  What’s more, athenahealth is tapping out its entire existing credit facility to offer an all-cash deal.

As for why athenahealth is so hot for Epocrates, I’ll let them explain. They say Epocrates ofers the following:

  • Better Information Access for Health Organizations — By combining Epocrates’ mobile expertise with knowledge and data from athenahealth’s cloud-based network, the combined company will be uniquely positioned to introduce new mobile applications that deliver high-value information to the clinical community when, where, and how they want it.
  • Advanced Mobile Workflows — the combined company will seek to pioneer new mobile workflows to improve provider efficiency and support care delivery outcomes; initial efforts will focus on care coordination, provider-to-provider communication, and patient engagement tools.
  • Accelerated Awareness and Growth Across the Physician Market — athenahealth would expand its current provider base of 38,000 to include the more than one million health care professionals on the Epocrates network, allowing athenahealth to build upon the highly favored Epocrates brand, recognized today by approximately 90 percent of practicing U.S. physicians.

You know what, all of the above makes a whole lot of sense. It seems far smarter to buy your way directly into phyician workflows with a trusted product like Epocrates than to compete against hundreds of me-too physician EMRs out there. Expect to see more deals like this in the future.