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IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract

Posted on January 12, 2015 I Written By

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they’re taking their bid. Here’s a short quote from that report:

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?

Muli-Billion Dollar DoD EHR Contract Promises Exciting Times in 2015

Posted on January 9, 2015 I Written By

This summer the DOD is set to award the multi billion dollar electronic health records contract. Each group that bid on it contains at least one company the provides product and one with heavy weight Gov’t/DOD presence.

Who is going to win? Who is in real trouble if they don’t? As far as the winner is concerned, my new, Christmas gift , Crystal Ball doesn’t have this level of experience yet. What I do know is that who the actual winner is will affect the entire Healthcare IT marketplace.

Of the bidders, there are a few companies “betting the farm” on winning this. More later on who, but they could be in serious trouble if they are not the winners.

The contract is scheduled to be awarded in early July. I’m sure there will be protests and pressure from the losers, so the contract’s full impact might be delayed briefly.

When all this is sorted out the need for qualified people to work on the project is going to be huge and securing a position there will be considered a prize for many because the contract itself is going to last for at least 8 years.

Basically this means that if you are looking for a position, there are going to be a huge amount of health IT job opportunities available. As professionals move to the DOD contract, most will need previous experience. Where are they going to come from? These experienced professional departures will create job opportunities when they leave.

For employers, you might want to look into your employee retention efforts. Some companies out there are going to have a major problem with retention. You may be putting out fires all summer long as the experienced health IT marketplace shifts.

Another Health System’s Finances Weighed Down By Epic Investment

Posted on December 26, 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.

While Memphis-based Baptist Memorial Health Care Corp. may intend to be “the high-quality and low-cost provider” in its region, spending $200 million on an EMR purchase has got to make that a bit more, shall we say, challenging.

While health systems nationwide are struggling with issues not of their own making, such as some states’ decision not to expand Medicaid, it appears that Baptist Memorial’s financial troubles have at least some relationship to the size of its 2012 investment in an Epic EMR platform.

Baptist, which let 112 workers go in September, has seen Standard & Poor’s lower its long-term rating on the health system’s bond debt twice since mid-2013.  Through June, the system’s losses totaled $124 million, according to S&P.

Baptist employs 15,000 workers at 14 hospitals located across the mid-south of the US, so the staffing cuts clearly don’t constitute a mass layoffs. What’s more, the layoffs are concentrated corporate services, Baptist reports, suggesting that the chain is being careful not to gut its clinical services infrastructure. In other words, I’m not suggesting that Baptist is completely falling apart, Epic investment or no.

But the health system’s financial health has deteriorated significantly over the past few years. After all, back in 2009, S&P gave Baptist Memorial a long-term ‘AA’ rating, based on its strong liquidity and low debt levels; history of positive excess income and good cash flow; and solid and stable market share in his total surface area, with favorable growth in metropolitan Memphis.

However, at this point Baptist is clearly struggling, so much so that is taking the extraordinary step of cutting the salaries of top executives in the system by 22% to 23%. That includes cutting the salary of health system CEO Jason Little. But this is clearly a symbolic gesture, as executive pay cuts can’t dent multimillion dollar operating revenue shortfalls.

So what will help Baptist improve its financial health? In public statements,  Baptist CEO Little has said that the hospitals’ length of stay has been excessive for the compensation that they get from payers, and that fixing this is his key focus. This problem, of course, is only likely to get worse as value-based reimbursement becomes the rule, so that strategy seems to make sense.

But Baptist is also going to have to live with its IT spending decisions, and it seems obvious that they’ve had long-term repercussions. I don’t think any outsider can say whether Baptist should have bought the Epic system, or how much it should have spent, but the investment has clearly been a strain.

Healthcare Interoperability – Learning From Proprietary PC History

Posted on December 16, 2014 I Written By

Interoperability; Some vendors have the unmitigated gall to try and keep their systems proprietary. When they refuse to make code or training available to others, competition will have difficulty achieving interoperability and customers will not be able to move too far from the vendor and their own profitability is secured. Competition is greatly reduced.  Capitalism at its finest.

A long, long time ago in a land far away, 4 vendors in the minicomputer and PC markets attempted to do just about the same thing. Wang, Data General and Digital Equipment were almost totally proprietary. Interoperability was little more than a dream. Proprietary would secure success.  The fourth company was the leader in the PC world. They also were not able to communicate with competitors and vice versa. For years, IBM compatible meant the difference between success and failure. Why? Try profit. If you control a market and can keep others away, profits remain high.   After a time, as with IBM there will come a time that giving up the proprietary nature of the product will cause an increase in sales and profits.

Throughout the 80’s and 90’s IBM’s competitors and some large users complained bitterly about all four company’s proprietary nature. The 3 minicomputer companies “bet the farm” that they could succeed by being proprietary. IBM did the same. The rest is history. One won and three lost.

Epic is in the same boat as those four. Being proprietary is increasing their profitability currently.  As time progresses will Epic decide that the time is right to allow the competition access to their product and code and, like IBM, will they do it at the right time to remain the market leader.  Any bets?

Epic Salary Info

Posted on November 20, 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.

Many of you probably remember that we helped promote an Epic Salary Survey. As promised, they’ve published the results of the survey and we thought that many readers would be interested in the Epic Salary survey results.

The survey had 753 responses. Not bad for an online survey that was promoted across various blogs and social media outlets. Although, as you can imagine, some states are better represented than others. It’s the challenge of having 50 states.

This is my favorite chart from the Epic salary survey results (you can download the full survey results and data by states here):
Average Epic Salary by Job Position

As I look at some of these salaries, I’m reminded of the doctor who said that they shouldn’t be spending time learning their EHR. The hospital CFO then told the doctor, “I’m sorry, but that Epic consultant costs a lot more than you.”

Now I’d like to see one from Meditech and Cerner.

John Glaser to Stay on as Senior VP of Cerner Upon Close of Acquisition

Posted on November 19, 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.

In case you’re living under a rock (or more affectionately, you’re too busy working to follow the inside baseball of EHR company acquisition), Cerner is set to acquire Siemens in late winter or early spring pending all the needed approvals for companies this size. Watching the merging of these two companies is going to be very interesting indeed.

Neil Versel just reported that John Glaser, current CEO of Siemens Health Services, has announced that upon close of acquisition he’ll be joining the Cerner team as a Senior VP. I also love that John Glaser made this announcement on the Cerner blog.

I think this is a big deal since I believe John Glaser is at the point in his career that he could do just about anything (or nothing) if that’s what he desired. The few times I’ve interacted with John Glaser, he was sincerely interested in moving healthcare forward through the use of advanced IT. I imagine that’s what’s motivating him to stay with Cerner. No doubt, Cerner is sitting on a huge opportunity.

In John Glaser’s blog post, he provided an interesting insight into Neal Patterson’s comments at the Cerner user conference:

In his CHC keynote address, Cerner CEO Neal Patterson did a masterful job of conveying Cerner’s commitment to patient-centered care. Before he spoke, a patient and her nurse were introduced with explanation that the woman’s life was saved by a Cerner sepsis alerting system. Neal then shared the incredible challenges he and his wife have faced in her battle with cancer because of limited interoperability.

Neal’s keynote was very personal – about how we can make a loved one’s care journey easier by ensuring that all records – every detail – are available electronically and accurately wherever the patient receives care. It was the case for interoperability but also the case for making a patient’s life easier and the care better.

It’s hard for me to say how much of this was theatrics, but I’m glad they are at least talking the right talk. I really do hope that Neal’s personal experience will drive interoperability forward. Neil Versel suggested that interoperability would be John Glaser’s focus at Cerner. I hope he’s successful.

While at CHIME, I talked with Judy Faulkner, CEO of Epic, and we talked briefly about interoperability. At one point in our conversation I asked Judy, “Do you know the opportunity that you have available to you?” She looked at me with a bit of a blank stare (admittedly we were both getting our lunch). I then said, “You are big enough and have enough clout that you (Epic) could set the standard for interoperability and the masses would follow.” I’m not sure she’s processed this opportunity, but it’s a huge one that they have yet to capitalize on for the benefit of healthcare as we know it.

The same opportunity is available for Cerner as well. I really hope that both companies embrace open data, open APIs, and interoperability in a big way. Both have stated their interest in these areas, but I’d like to see a little less talk…a lot more action. They’re both well positioned to be able to make interoperability a reality. They just need to understand what that really means and go to work on it.

I’m hopeful that both companies are making progress on this. Having John Glaser focused on it should help that as well. The key will be that both companies have to realize that interoperability is what’s best for healthcare in general and in the end that will be what’s best for their customers as well.

Just Epic Salary Info Survey

Posted on October 24, 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.

One of our most popular posts was one about Epic Salaries. Although, that was focused on what Epic payed its employees. Many people are interested in what Epic experts are getting paid as full time employees at hospitals or as Epic EHR consultants.

In an effort to better understand what Epic experts can expect to get paid, someone has put together a survey they call JESI (Just Epic Salary Information). I love transparency and so I want to support their efforts to gather as many Epic Salaries as possible. So, if you are an Epic expert, help us out and fill out the quick Epic Salary Information form. Don’t worry. They don’t ask for your contact information, organization name, or anything else.

The other reason I want to support this effort is that all of the aggregate information will be published for free on JustEpicSalary.info. I’ll be interested to see the results of the survey.

Do you know of any other sources of Epic salary information? How do you decide what you pay your Epic experts?

This also reminds me of a recent discussion I had. This hospital CIO told me that they were talking with their doctor about their Epic implementation. The doctor was complaining about how much time they were spending to get Epic working the right way. The doctor asked why some Epic consultants couldn’t just do this for him. Turns out, the doctor was the cheap resource. Having an Epic consultant do it, would have been much more expensive. Doctors don’t hear that very often.

Investor Wants to Take Down Epic

Posted on October 13, 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.

I recently came across a really interesting comment from Chamath Palihapitiya, a venture capitalist (made his money working at Facebook), who commented on the healthcare industry and how he wanted to invest in a startup company that would take down Facebook. I embedded the full video below. His comments about EHR and Epic start at about 52:38 or you can click here to see it.

Here’s a great quote for those who can’t watch the video:

“Somebody has to go after the electronic medical record market in a really big way. Let’s go and take down this company call Epic which is this massive, old conglomerate. It’s like the IBM of healthcare.”

After saying this, he talks about how he and other VC investors like John Doerr could call people from Obama (for meaningful use stage 3) to Mayo Clinic to help a startup company try and take down Epic. He even asserts that he’d call Mayo Clinic and suggest that they should rip out Epic and go with this startup company.

Everyone reading this blog know that it won’t be nearly this simple to convince any hospital that’s on Epic to leave it behind. I agree with Chamath that it will happen at some point, but it won’t be nearly as easy as what he describes. Chamath also suggested that it might take $100 million and you might fail, but what a way to fail.

It certainly provides an interesting view into the way these venture capitalists and many startup companies approach a problem. However, I take a more nuance and practical approach of how I think that Epic will be disrupted. I think that it will require a mix of a new technology paired with a dynamic CIO that’s friends with the hospital IT leadership. You need that mix of amazing technology with insider credibility or it won’t be a success. Plus, you’re not going to go straight in and take out Epic. You’re going to start with a hospital department and create something amazing. Then, that will make the rest of the hospital jealous and you’ll expand from there until you can replace Epic. That’s how I see it playing out, but it likely won’t happen until after the MU dollars are spent.

Chamath’s comments were also interesting, because it shows that he doesn’t know the healthcare market very well. First, he said that meaningful use was part of ACA, but meaningful use is part of ARRA (the HITECH Act) and not ACA. This is a common error by many and doesn’t really impact the points he made. Second, he said that Epic is a big conglomerate. Epic is the farthest thing from a conglomerate that you can find. Has Epic ever acquired any company or technology? Cerner, McKesson, GE, etc could be called conglomerates, but Epic is not. Again, a subtle thing, but shows Chamath’s depth of understanding in the industry. It makes sense though. He isn’t an expert in healthcare IT. He’s an expert in seeing market opportunities. No doubt, disrupting Epic and Cerner would make for a massive company.

More Epic Interoperability Discussion

Posted on October 7, 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.

Looks like Epic is starting to open up and join the conversation about healthcare interoperability. The latest is an article in the New York Times which includes a few comments from Judy Faulkner, CEO of Epic. Here’s the main comments from Judy:

In 2005, when it became clear to her [Judy] that the government was not prepared to create a set of rules around interoperability, Ms. Faulkner said, her team began writing the code for Care Everywhere. Initially seen as a health information exchange for its own customers, Care Everywhere today connects hospitals all over the country as well as to various public health agencies and registries.

“Let’s say a patient is coming from U.C.L.A. and going to the University of Chicago, an Epic-to-Epic hospital. Boom. That’s easy,” Ms. Faulkner said. “These are hospitals that have agreed to the Rules of the Road, a legal contract, that says the other organization is going to take good care of the data.”

This is a really interesting approach. Blame the government for not applying a standard. Talk about how you’ve had to do it yourself and that’s why you built Care Everywhere. I wish that Judy would come out with the heart of the matter. Epic’s customers never asked for it and so they never did it. I believe that’s the simple reality. Remember that interoperability might be a big negative for many healthcare systems. If they’re interoperable, that could be a hit to revenue. Hopefully ACOs and other value based reimbursement will change this.

The key to coming clean like this though, is to come out with a deep set of initiatives that show that while it wasn’t something you worked on in the past, you’re going all in on interoperability now. We’re a very forgiving people, and if Epic (or any other large EHR vendor for that matter) came out with a plan to be interoperable, many would jump on board and forgive them for past transgressions (wherever the blame may lie).

Unfortunately, we don’t yet see this. I’d love to catch up with Judy Faulkner at CHIME and talk to her about it. The key will be to have a full spectrum interoperability plan and not just Care Everywhere that doesn’t work everywhere. Remember that Epic has charts for about 50% of the US patient population, but that’s still only 50%. Plus, of the 50% of patients they do have, a very very small percentage of them are all stored in the same Epic system. My guess would be that 99+% of patients who have a record in Epic have their medical records in other places as well. This means that Epic will need data from other non-Epic systems.

As I’ve said before, Epic wouldn’t need to wait for the government to do this. They are more than large enough to set the standard for the industry. In fact, doing so puts them in a real position of power. Plus, it’s the right thing to do for the US healthcare system.

Will the interoperability be perefect? No. It will take years and years to get everything right, but that’s ok. Progress will be better than what we have now. I love this quote from the NY Times article linked above:

“We’ve spent half a million dollars on an electronic health record system about three years ago, and I’m faxing all day long. I can’t send anything electronically over it,” said Dr. William L. Rich III, a member of a nine-person ophthalmology practice in Northern Virginia and medical director of health policy for the American Academy of Ophthalmology.

I hope that Epic continues down the path to interoperability and becomes even more aggressive. I think the climate’s right for them to make it happen. They’re in a really unique position to be able to really change the way we think and talk about interoperability. I’m interested to see if they seize the opportunity or just talk about it.

Of course, we’ve focused this article talking about Epic. That’s what happens when you’re the A list celebrity on the red carpet. People want to talk about you. The NY Times article pretty aptly points out that the other EHR vendors aren’t much more or less interoperable than Epic. Feel free to replace Epic with another large EHR vendor’s name and the story will likely read the same.

My hope is that EHR vendors won’t wait for customers to demand interoperability, but will instead make interoperability so easy that their customers will love taking part. Watch for a future series of posts on Healthcare Intoperability and why this is much easier said than done.

EMR Change Cuts Cardiac Telemetry Use Substantially

Posted on September 25, 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.

Changing styles of medical practice can be really tough, even if major trade organization sticks its oar in to encourage new behavior from docs.

Such is the situation with cardiac telemetry, which is listed by the American Board of Internal Medicine Foundation as either unnecessary or overused in most cases. But a recent piece of research demonstrated that configuring an EMR to help doctors comply with the guideline can help hospitals lower needless cardiac monitoring substantially.

Often, it takes a very long time to get doctors to embrace new guidelines like these, despite pressure from payers, employers and even peers. (Physicians may turn on a dime and try out a new drug when the right pharmaceutical rep shows up, but that’s another story.) Doctors say they stick to their habits because of patient, institutional or personal preferences, as well as fear of lawsuits.

But according to a recent study appearing in JAMA Internal Medicine, reprogramming its Centricity EMR did the trick for Wilmington, Del.-based Christiana Care Health System.

To curb the use of cardiac telemetry that was unnecessary, Christiana Care removed the standard option for doctors to order cardiac monitoring outside of AHA guidelines, and required them to take an extra step to order this type of test.

Meanwhile, when the cardiac monitoring order did fall within AHA guidelines, Christiana Care added an AHA-recommended time frame for the monitoring. After that time passed, the EMR notified nurses to stop the monitoring or ask physicians if they believed it would be unsafe to stop.

The results were striking. After implementing the changes in the EMR, the health systems average daily not intensive care unit patients with cardiac monitoring fell by 70%. What’s more, Christiana Care’s average daily cost of administering  non-ICU cardiac monitoring held by 70%, from $18,971 to $5,772.

Christiana Care’s health IT presence is already well ahead of many hospitals — it’s reached Stage 6 of the HIMSS EMRAM scale — so it’s not surprising to see it leading the way in shaping physician behavior.

The question now is how the system builds on what it’s learned. Having survived a politically-sensitive transition without creating a revolution in its ranks, I’d argue the time is now to jump in and work on compliance with other clinical guidelines. With pressure mounting to deliver efficient care, it’d be smart to keep the ball rolling.