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Surescripts Deal Connects EMR Vendors And PBMs To Improve Price Transparency

Posted on November 22, 2017 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.

I’m no expert on the pharmacy business, but from where I sit as a consumer it’s always looked to me as though pharmaceutical pricing is something of a shell game. It makes predicting what your airline ticket will cost seem like child’s play.

Yes, in theory, the airlines engage in demand-oriented pricing, while pharma pricing is based on negotiated prices spread among multiple contracted parties, but in either case end-users such as myself have very little visibility into where these numbers are coming from.  And in my opinion, at least, that’s not good for anyone involved. You can say “blah blah blah skin in the game” all you want, but co-pays are a poor proxy for making informed decisions as a patient as to what benefits you’ll accrue and problems you face when buying a drug.

Apparently, Surescripts hopes to change the rules to some degree. It just announced that it has come together with two other interest groups within the pharmacy supply chain to offer patient-specific benefit and price information to providers at the point of care.

Its partners in the venture include a group of EMR companies, including Cerner, Epic, Practice Fusion and Aprima Medical Software, which it says represent 53% of the U.S. physician base. It’s also working with two pharmacy benefit managers (CVS Health and Express Scripts) which embrace almost two-thirds of US patients.

The new Surescripts effort actually has two parts, a Real-Time Prescription Benefit tool and an expanded version of its Prior Authorization solution.  Used together, and integrated with an EHR, these tools will clarify whether the patient’s health insurance will cover the drug suggested by the provider and offer therapeutic alternatives that might come at a lower price.

If you ask me, this is clever but fails to put pressure on the right parties. You don’t have to be a pharmaceutical industry expert to know that middlemen like PBMs and pharmacies use a number of less-than-visible stratagems jack up drug prices. Patients are forced to just cope with whatever deal these parties strike among themselves.

If you really want to build a network which helps consumers keep prices down, go for some real disclosure. Create a network which gathers and shares price information every time the drug changes hands, up to and including when the patient pays for that drug. This could have a massive effect on drug pricing overall.

Hey, look at what Amazon did just by making costs of shipping low and relatively transparent to end-users. They sucked a lot of the transaction costs out of the process of shipping products, then gave consumers tools allowing them to watch that benefit in action.

Give consumers even one-tenth of that visibility into their pharmacy supply chain, and prices would fall like a hot rock. Gee, I wonder why nobody’s ever tried that. Could it be that pharmaceutical manufacturers don’t want us to know the real costs of making and shipping their product?

Epic Mounts Clumsy Public Defense On False Claims Lawsuit

Posted on November 6, 2017 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 former employee of a health system using Epic filed a False Claims Act whistleblower suit claiming that the vendor’s platform overbills for anesthesia services by default. The suit claims that Epic’s billing software double-bills both Medicare and Medicaid for anesthesia, as well as commercial payers.

At this point, let me be clear that I’m not accusing anyone of anything, but in theory, this could be a very big deal. One could certainly imagine a scenario in which multiple Epic customers colluded to permit this level of overbilling, which could generate staggering levels of overpayment. If so, one could imagine hospitals and health systems paying out judgments that add up to billions of dollars. To date, though, nobody’s made such a suggestion. In fact, Epic has said essentially the opposite and pointed to the need to understand how medical billing works, but we’ll get to that.

In the suit, which was filed in 2015 but unsealed this month, Geraldine Petrowski contended that Epic’s software was billing for both the base units of anesthesia for procedures and the time the procedure took.

Petrowski, a former employee with the compliance team at Raleigh, N.C.-based WakeMed Health & Hospitals, alleges that setting the billing to these defaults has resulted in “hundreds of millions of dollars in fraudulent bills” submitted to Medicare, Medicaid and other payers. (WakeMed is an Epic customer.)

According to an article appearing in Modern Healthcare, Petrowski developed these concerns when she worked with Epic as the provider’s liaison for its software implementation between 2012 and 2014. In the complaint, she says that she raised these concerns with Epic, but got a dismissive response. Eventually, after Petrowski kept up the pressure for a while, Epic fixed the billing issue — but only for WakeMed.

Apparently, the U.S. Department of Justice reviewed Petrowski’s case and decided not to intervene, a fact which Epic has not-surprisingly mentioned every chance it gets. Perhaps more tellingly, the vendor has suggested that Petrowski filed the suit largely because she’s clueless. “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works,” Epic spokesperson Meghan Roh told the magazine.

Now, I don’t want to go off on a rant here, but if the best public defense Epic can mount in this case is to offer some mixture of “everybody’s doing it” and “you’re a big dummy,” you’ve got to wonder what it’s got to hide.

Not only that, trying to brush off the suit as the product of ignorance or inexperience makes no sense given what’s involved. While False Claims whistleblowers can collect a very large payoff, getting there can take many years of grueling work, and their odds of prevailing aren’t great even if they make it through the torturous litigation process.

No, I’m more inclined to think that Epic has tipped its hand already. I’d argue that fixing only the WakeMed billing system shows what the legal folks call mens rea – a guilty mind — or at least a willingness to ignore potential wrongdoing. Not only that, if the system was operating as expected, why would Epic have gotten involved in the first place? Its consulting services don’t come cheap, and I’m guessing that Petrowski didn’t have the authority to pay for them.

It doesn’t look good, people…it just doesn’t look good.

Sure, the hospitals and health systems using Epic’s billing solution are ultimately responsible for the results. Maybe Epic is completely blameless in the matter this case. Regardless, if Epic’s hands are clean, it could do a better job of acting like it.

Visible and Useful Patient Data in an Era of Interoperability Failure

Posted on October 13, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor.
Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare.
twitter: @coherencemed

Health record interoperability and patient data is a debated topic in Health IT. Government requirements and business interests create a complex exchange about who should own data and how it should be used and who should profit from patient data. Many find themselves asking what the next steps in innovation are. Patient data, when it is available, is usually not in a format that is visible and useful for patients or providers. The debate about data can distract from progress in making patient data visible and useful.

Improvements in HealthIT will improve outcomes through better data interpretation and visibility. Increasing the utility of health data is a needed step. Visibility of patient data has been a topic of debate since the creation of electronic health records. This was highlighted in a recent exchange between former vice president Joe Biden and Judy Faulkner, CEO of Epic Systems.

Earlier this year at the Cancer Moonshoot, Faulkner expressed her skepticism about the usefulness of allowing patients access to their medical records. Biden replied, asking Faulkner for his personal health data.

Faulkner was quick to retort, questioning why Mr. Biden wanted his records, and reportedly responded “Why do you want your medical records?” There are a thousand pages of which you understand 10.”

My interpretation of her response-“You don’t even know what you are asking. Do not get distracted by the shiny vendor trying to make money from interpreting my company’s data”

As reported in Politico Biden–and really, I think that man can do no wrong, responded, “None of your business.”

In the wake of the Biden Faulkner exchange, the entire internet constituency of Health IT and patient records had an ischemic attack. Since this exchange we’ve gone on to look at interoperability in times of crisis. We’ve had records from Houston and Puerto Rico and natural disasters. The importance of sharing data and the scope of useful data is the same. 

During what I call the beginning of several months of research about the state of interoperability I started reading about the Biden and Faulkner exchange. This was not the first time I had been reading extensively about patient data and if EHR and EMR data is useful. It just reminded me of the frustrations I’ve heard for years about EHR records being useless. Like many of us, I disappeared down the rabbit hole of tweets about electronic health records for a full day. Patient advocates STILL frustrated by the lack of cooperation between EHR and EMR vendors found renewed vigor; they cited valid data. Studies were boldly thrown back and the exchange included some seriously questionable math and a medium level of personal attack.

Everyone was like, Are we STILL on this problem where very little happens and it’s incredibly complex? How? How do we still not have a system that makes patient data more useful? Others were like, Obviously it doesn’t make sense because A) usefulness in care, and B) money.

Some argued that patients just want to get better. Others pointed out that acting like patients were stupid children not only causes a culture of contempt for providers and vendors alike, but also kills patients. Interestingly, Christina Farr CNBC reported that the original exchange may have been more civil than originally interpreted. 

My personal opinion: Biden obviously knew we needed to talk about patient rights, open data, and interoperability more. It has had more coverage since then. I don’t know Faulkner, but it sounds like a lot of people on Twitter don’t feel like she is very cooperative. She sounds like a slightly savage businesswoman, which for me is usually a positive thing. I met Peter from Epic who works with interoperability and population health and genomics and he was delightful.

Undeniably, there is some validity to Judy’s assertion that the data would not be useful to Biden; EHR and EMR data, at least in the format available from the rare cooperative vendors, is not very useful. They are a digital electronic paper record. I am willing to bet Biden–much as I adore the guy–didn’t even offer a jump drive on which to store his data. The potential of EHR data visualization to improve patient outcomes needs more coverage. Let’s not focus on the business motivations of parties that don’t want to share their data, let’s look at potential improvements in data usefulness. 

It was magic because I had just had a conversation about data innovation with Dr. Michael Rothman. An early veteran in the artificial intelligence field, Dr. Rothman worked in data modeling before the AI winter of the 80s and the current resurgence in investment and popularity. He predates the current buzz cycle of blockchain and artificial intelligence everything. With many data scientists frustrated by an abandonment of elegant, simple solutions in favor of venture capital and sexy advertising vaporware, it is timely to look at tools that improve outcomes.

In speaking with Dr. Rothman, I was surprised by the cadence of his voice, he asked me what I knew about the history of artificial intelligence, and I asked him to tell his data story. He started by outlining the theory of statistical modeling and data dump in neural net modeling. His company, PeraHealth, represents part of the solution for making EMR and EHR data useful to clinicians and patients.

The idea that data is going to give you the solution is, in a sense, slightly possible but extremely unlikely. If you look at situations where people have been successful, there is a lot of human ingenuity that goes into selecting and transforming the variables into meaningful forms before building the neural network or deep learning algorithm. Without a framework of understanding, a lot of EHR data is simply a data dump that lacks clinical knowledge or visualization to provide appropriate scaffolding.  You do need ingenuity, and you do need the right data. There are so many problems and complexities with data that innovation and ingenuity is lagging behind with healthIT.

The question is – is the answer you are looking for in the input data? If you have the answer in the data, you will be able to provide insights based on it. Innovation in healthcare predictions and patient records will come from looking at data sets that are actually predictive of health.

Dr. Rothman’s work in healthcare started with a medical error. His mother had valve replacement surgery and came through in good shape. Although initially she was recovering quickly, she started to deteriorate after a few days. And the problem was that the system made it difficult to see.  Each day she was evaluated.  Each day her condition was viewed as reasonable given her surgery and age.  What they couldn’t see was that each day she was getting worse.  They couldn’t see the trend.  She was discharged and returned to the ED 4-days later and died.

As a scientist, he recognized that the hospital staff didn’t have everything they needed to avoid an error like this. He approached the hospital CEO and asked for permission to help them solve the problem. Dr. Rothman explained, I didn’t feel that the doctors had given poor medical care, this was a failure of the system.

The hospital CEO did something remarkable. They shared their data. In a safe system they allowed an expert in data science to come in to see what he could find in their patient records, rather than telling him he probably wouldn’t understand the printout. The hospital was an early adopter of EHR records, so they were able to look at a long history of data to find what was being missed. Using vital signs, lab tests, and importantly, an overlooked source of data, nursing notes, Dr. Rothman (and his brother) found a way to synthesize a unified score, a single number which captures the overall condition of the patient, a single number which was fed from the EMR and WOULD show a trend.  There is an answer if you include the right data.  

Doctors and nurses look at a myriad of data and synthesize it, to reach an understanding.  Judy is right that a layman looking at random pieces of data will not likely gain much understanding, BUT they may.  And with more help they might.  Certainly, they deserve a chance to look.  And certainly, the EMR and EHR companies have an obligation to present the data in some readable form.

Patients should be demanding data, they should be demanding hospitals give them usable care and normalize data based on their personal history to help save their lives.

Based on this experience, Michael and Steven built the Rothman Index, a measure of patient health based on analytics that visualizes data found in EHRs. They went on to found PeraHealth, which enables nursing kiosks to show the line and screens to see if any patients decline. In some health systems, an attending physician can get an alert about patients in danger. The visualization from the record isn’t just a screen by the patient, it is also on the physicians and nurses’ screens and includes warnings. Providers have time to evaluate what is wrong before it is too late. The data in the health record is made visual and can be a tool for providers.


Visualization of Patient Status with the Rothman Index and Perahealth

Is Perahealth everywhere? Not yet. For every innovation and potential improvement there is a period of time where slow adopters wait and invest in sure bets. Just like interoperable data isn’t an actuality in a system that desperately needs it, this is a basic step toward improving patient outcomes. Scaling implementation of an effective data tool is not always clear to hospital CMIO and CEO teams.  The triage of what healthIT solution a healthcare system chooses to implement is complex. Change also requires strong collaborative efforts and clear expectations. Often, even if hospital systems know something provides benefits to patients, they don’t have the correct format to implement the solution. They need a strategy for adoption and a strong motivation. It seems that the strongest motivations are financial and outcomes based. The largest profit savings with the minimum effort usually takes adoption precedent. This should also be aligned with end users- if a nurse uses the system it needs to improve their workflow, not just give them another task.

One of the hospitals that is successfully collaborating to make patient data more useful and visual is Houston Methodist. I spoke to Katherine Walsh, Chief Nursing Officer from Houston Methodist about their journey to use EHR data with Perahealth. She explained it to me- Data is the tool, without great doctors and nurses knowing the danger zone, it doesn’t help. This reminded me of Faulkner’s reaction that not all patient data is useful. Clinical support should be designed around visible data to give better care. Without a plan, data is not actionable. Katherine explained that when nurses could see that the data was useful, they also had to make sure their workflow included timely records. When EHR data is actually being used in the care of patients, suddenly data entry workflow changes. When nurses and doctors can see that their actions are saving lives, they are motivated.
The process to change their workflow and visualize patient data did not happen overnight. In the story of Houston Methodist’s adoption of Perahealth, Walsh said they wanted to make sure they helped doctors and nurses understand what the data meant.  “We put large screens on all the units- you can immediately see the patients that are at risk- it’s aggregated by the highest risk factor.” If you are waiting for someone to pull this data up on their desktop, you are waiting for them to search something. But putting it on the unit where you can see it makes it much easier to round, and makes it much easier to get a sense of what is going on. You can always identify what and who is at risk because it’s on a TV screen. The Houston Methodist team showed great leadership in nursing informatics, improving outcomes and using an internal strategy for implementation.

They normalize the variants for each person- a heart rate of 40 for a runner might be normal- then on the next shift 60 seems normal- then at 80 it also seems normal- you can tell them when you want an alert. To help with motivation, Walsh needed to make the impact of PeraHealth visual. They hung 23 hospital gowns around a room, representing the patients they had saved using the system.
The future of electronic health records will be about creating usable data, not just a data dump of fields. It is transforming EHRs from a cost hemorrhage to a life-saving tool through partnerships. Physicians don’t want another administrative task or another impersonal device. Nurses don’t want to go through meaningless measures and lose track of patients during shift changes. Show them the success they’ve had and let the data help them give great care.

Hospital administrators don’t want another data tool that doesn’t improve patient outcomes but has raised capital on vaporware. Creators don’t want more EHR companies that don’t know how to work with agile partners to create innovation.

The real ingenuity is in understanding – what data do you need? What data do patients need? Who can electronic healthcare record companies partner with to bridge the data divide?

We can bridge the gap of electronic health records that aren’t legible or useful to patients and create tools to save lives. Tools like those from PeraHealth are the result of a collaborative effort to take the data we have and synthesize it and visualize it and let care providers SEE their patients.  This saves lives.

Without this, the data is there, it’s just not usable.

Don’t just give the patients their data, show them their health.

AHA Asks Congress To Reduce Health IT Regulations for Medicare Providers

Posted on September 22, 2017 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.

The American Hospital Association has sent a letter to Congress asking members to reduce regulatory burdens for Medicare providers, including mandates affecting a wide range of health IT services.

The letter, which is addressed to the House Ways and Means Health subcommittee, notes that in 2016, CMS and other HHS agencies released 49 rules impacting hospitals and health systems, which make up nearly 24,000 pages of text.

“In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them,” says the letter, which was signed by Thomas Nickels, executive vice president of government relations and public policy for the AHA. The letter came with a list of specific changes AHA is proposing.

Proposals of potential interest to health IT leaders include the following. The AHA is asking Congress to:

  • Expand Medicare coverage of telehealth to patients outside of rural areas and expand the types of technology that can be used. It also suggests that CMS should automatically reimburse for Medicare-covered services when delivered via telehealth unless there’s an individual exception.
  • Remove HIPAA barriers to sharing patient medical information with providers that don’t have a direct relationship with that patient, in the interests of improving care coordination and outcomes in a clinically-integrated setting.
  • Cancel Stage 3 of the Meaningful Use program, institute a 90-day reporting period for future program years and eliminate the all-or-nothing approach to compliance.
  • Suspend eCQM reporting requirements, given how difficult it is at present to pull outside data into certified EHRs for quality reporting.
  • Remove requirements that hospitals attest that they have bought technology which supports health data interoperability, as well as that they responded quickly and in good faith to requests for exchange with others. At present, hospitals could face penalties for technical issues outside their control.
  • Refocus the ONC to address a narrower scope of issues, largely EMR standards and certification, including testing products to assure health data interoperability.

I am actually somewhat surprised to say that these proposals seem to be largely reasonable. Typically, when they’re developed by trade groups, they tend to be a bit too stacked in favor of that group’s subgroup of concerns. (By the way, I’m not taking a position on the rest of the regulatory ideas the AHA put forth.)

For example, expanding Medicare telehealth coverage seems prudent. Given their age, level of chronic illness and attendant mobility issues, telehealth could potentially do great things for Medicare beneficiaries.

Though it should be done carefully, tweaking HIPAA rules to address the realities of clinical integration could be a good thing. Certainly, no one is suggesting that we ought to throw the rulebook out the window, it probably makes sense to square it with today’s clinical realities.

Also, the idea of torquing down MU 3 makes some sense to me as well, given the uncertainties around the entirety of MU. I don’t know if limiting future reporting to 90-day intervals is wise, but I wouldn’t take it off of the table.

In other words, despite spending much of my career ripping apart trade groups’ legislative proposals, I find myself in the unusual position of supporting the majority of the ones I list above. I hope Congress gives these suggestions some serious consideration.

Rush Sues Patient Monitoring Vendor, Says System Didn’t Work

Posted on August 25, 2017 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.

Rush University Medical Center has filed suit against one of its health IT vendors, claiming that its patient monitoring system didn’t work as promised and may have put patients in danger.

According to a story in the Chicago Tribune, Rush spent $18 million installing the Infinity Acute Monitoring Solution system from Telford, PA-based Draeger Inc. between 2012 and early 2016.  The Infinity system included bedside monitors, larger data aggregating monitors at central nursing stations, battery-powered portable monitors and M300 wireless patient-worn monitors.

However, despite years of attempting to fix the system, its patient alarms were still unreliable and inaccurate, it contends in the filing, which accuses Draeger of breach of contract, unjust enrichment and fraud.

In the suit, the 664-bed hospital and academic medical center says that the system was dogged by many issues which could have had an impact on patient safety. For example, it says, the portable monitors stopped collecting data when moved to wireless networks and sometimes stole IP addresses from bedside monitors, knocking the bedside monitor off-line leaving the patient unmonitored.

In addition, the system allegedly sent out false alarms for heart arrhythmia patients with pacemakers, distracting clinicians from performing their jobs, and failed monitor apnea until 2015, according to the complaint. Even then, the system wasn’t monitoring some sets of apnea patients accurately, it said. Near the end, the system erased some patient records as well, it contends.

Not only that, Draeger didn’t deliver everything it was supposed to provide, the suit alleges, including wired-to-wireless monitoring and monitoring for desaturation of neonatal patients’ blood oxygen.

As if that weren’t enough, Draeger didn’t respond effectively when Rush executives told it about the problems it was having, according to the suit. “Rather than effectively remediating these problems, Draeger largely, and inaccurately, blamed them on Rush,” it contends.

While Draeger provided a software upgrade for the system, it was extremely difficult to implement, didn’t fix the original issues and created new problems, the suit says.

According to Rush, the Draeger system was supposed to last 10 years. However, because of technical problems it observed, the medical center replaced the system after only five years, spending $30 million on the new software, it says.

Rush is asking the court to make Draeger pay that the $18 million it spent on the system, along with punitive damages and legal fees.

It’s hard to predict the outcome of such a case, particularly given that the system’s performance has to have depended in part on how Rush managed the implementation. Plus, we’re only seeing the allegations made by Rush in the suit and not Draeger’s perspective which could be very different and offer other details. Regardless, it seems likely these proceedings will be watched closely in the industry. Regardless of whether they are at fault or not, no vendor can afford to get a reputation for endangering patient safety, and moreover, no hospital can afford to buy from them if they do.

Is Allscripts An Also-Ran In The Hospital EMR Business?

Posted on August 18, 2017 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.

It all began with a question, as many classic tales do. Someone writing for the HIStalk.com website  – I think it was ever-anonymous, eponymous  leader Mr. HISTalk – asked readers to answer the question “Who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?”

The survey results were themselves worth a read:

* Approximately 29% voted for “McKesson customers”
* About 27% voted for “Allscripts customers”
* 8.4% voted for “McKesson shareholders”
* Roughly 23% voted for “Allscripts shareholders”
* About 13% voted for “Allscripts competitors”

Two things about these responses interested me. One is that almost a third of respondents seem to think McKesson will make the bigger score after being acquired by Allscripts. The other is that a not-inconsiderable 13% of the site’s well-informed readers think the deal will help Allscripts’ competitors. If these readers are right, perhaps Allscripts should rethink the deal.

I was even more engaged by the analysis that followed, which the writer took a close look at the dynamics of the hospital EMR market and commented on how Allscripts fit in. The results weren’t surprising, but again, if I were running Allscripts I’d take the following discussion seriously.

After working with data supplied by Blain Newton, EVP of HIMSS Analytics, the writer drew some firm conclusions. Here are some of the observations he shared:

  • While McKesson has twice as many hospitals as Allscripts, most of these hospitals have less than 150 beds, which means that the acquisition may offer less benefit, he suggests.
  • In addition to having only 3% of hospitals overall, Allscripts controls only 6% of the 250+ bed hospital market, which probably doesn’t position it for success. In contrast, he notes, Epic controls 20% of this market and Meditech 19%.
  • His sense is that while hospitals typically want a full suite of products when they work with Epic, Cerner or Meditech, Allscripts customers may be more prone to buying just a few key systems.
  • Ultimately, he argues, Cerner, Epic and Meditech have a commanding lead in this market, for reasons which include that the three are well ahead when it comes to the overall number of hospital served.
  • Given his premise, he believes that Epic is at the top of the pyramid, as it has almost double the number of hospitals with 500+ beds that Cerner does.

To cap off his analysis, Mr. HISTalk concludes that market forces make it unlikely that a dark horse will squeeze out one of the top hospital EMR vendors: “Everybody else is eating their dust and likely to lose business due to hospital consolidation and a shift toward the most successful vendors as much as all of us who – for our own reasons – wish that weren’t the case.”

It would take a separate analysis to predict whether the top three hospital EMR vendors are likely to win out over each other, but Epic seems to hold the most cards. Last year, I wrote a piece suggesting that Cerner was edging up on Epic, but I’m not sure whether or not my logic still holds. Epic may indeed be King of the (HIT) Universe for the foreseeable future.

Is It Time To Put FHIR-Based Development Front And Center?

Posted on August 9, 2017 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.

I like to look at questions other people in the #HIT world wonder about, and see whether I have a different way of looking at the subject, or something to contribute to the discussion. This time I was provoked by one asked by Chad Johnson (@OchoTex), editor of HealthStandards.com and senior marketing manager with Corepoint Health.

In a recent HealthStandards.com article, Chad asks: “What do CIOs need to know about the future of data exchange?” I thought it was an interesting question; after all, everyone in HIT, including CIOs, would like to know the answer!

In his discussion, Chad argues that #FHIR could create significant change in healthcare infrastructure. He notes that if vendors like Cerner or Epic publish a capabilities-based API, providers’ technical, clinical and workflow teams will be able to develop custom solutions that connect to those systems.

As he rightfully points out, today IT departments have to invest a lot of time doing rework. Without an interface like FHIR in place, IT staffers need to develop workflows for one application at a time, rather than creating them once and moving on. That’s just nuts. It’s hard to argue that if FHIR APIs offer uniform data access, everyone wins.

Far be it from me to argue with a good man like @OchoTex. He makes a good point about FHIR, one which can’t be emphasized enough – that FHIR has the potential to make vendor-specific workflow rewrites a thing of the past. Without a doubt, healthcare CIOs need to keep that in mind.

As for me, I have a couple of responses to bring to the table, and some additional questions of my own.

Since I’m an HIT trend analyst rather than actual tech pro, I can’t say whether FHIR APIs can or can’t do what Chat is describing, though I have little doubt that Chad is right about their potential uses.

Still, I’d contend out that since none other than FHIR project director Grahame Grieve has cautioned us about its current limitations, we probably want to temper our enthusiasm a bit. (I know I’ve made this point a few times here, perhaps ad nauseum, but I still think it bears repeating.)

So, given that FHIR hasn’t reached its full potential, it may be that health IT leaders should invest added time on solving other important interoperability problems.

One example that leaps to mind immediately is solving patient matching problems. This is a big deal: After all, If you can’t match patient records accurately across providers, it’s likely to lead to wrong-patient related medical errors.

In fact, according to a study released by AHIMA last year, 72 percent of HIM professional who responded work on mitigating possible patient record duplicates every week. I have no reason to think things have gotten better. We must find an approach that will scale if we want interoperable data to be worth using.

And patient data matching is just one item on a long list of health data interoperability concerns. I’m sure you’re aware of other pressing problems which could undercut the value of sharing patient records. The question is, are we going to address those problems before we began full-scale health data exchange? Or does it make more sense to pave the road to data exchange and address bumps in the road later?

We Can’t Afford To Be Vague About Population Health Challenges

Posted on June 19, 2017 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.

Today, I looked over a recent press release from Black Book Research touting its conclusions on the role of EMR vendors in the population health technology market. Buried in the release were some observations by Alan Hutchison, vice president of Connect & Population Health at Epic.

As part of the text, the release observes that “the shift from quantity-based healthcare to quality-based patient-centric care is clearly the impetus” for population health technology demand. This sets up some thoughts from Hutchison.

The Epic exec’s quote rambles a bit, but in summary, he argues that existing systems are geared to tracking units of care under fee-for-service reimbursement schemes, which makes them dinosaurs.

And what’s the solution to this problem? Why, health systems need to invest in new (Epic) technology geared to tracking patients across their path of care. “Single-solution systems and systems built through acquisition [are] less able to effectively understand the total cost of care and where the greatest opportunities are to reduce variation, improve outcomes and lower costs,” Hutchison says.

Yes, I know that press releases generally summarize things in broad terms, but these words are particularly self-serving and empty, mashing together hot air and jargon into an unappetizing patty. Not only that, I see a little bit too much of stating as fact things which are clearly up for grabs.

Let’s break some of these issues down, shall we?

  • First, I call shenanigans on the notion that the shift to “value-based care” means that providers will deliver quality care over quantity. If nothing else, the shifts in our system can’t be described so easily. Yeah, I know, don’t expect much from a press release, but words matter.
  • Second, though I’m not surprised Hutchison made the argument, I challenge the notion that you must invest in entirely new systems to manage population health.
  • Also, nobody is mentioning that while buying a new system to manage pop health data may be cleaner in some respects, it could make it more difficult to integrate existing data. Having to do that undercuts the value of the new system, and may even overshadow those benefits.

I don’t know about you, but I’m pretty tired of reading low-calorie vendor quotes about the misty future of population health technology, particularly when a vendor rep claims to have The Answer.  And I’m done with seeing clichéd generalizations about value-based care pass for insight.

Actually, I get a lot more out of analyses that break down what we *don’t* know about the future of population health management.

I want to know what hasn’t worked in transitioning to value-based reimbursement. I hope to see stories describing how health systems identified their care management weaknesses. And I definitely want to find out what worries senior executives about supporting necessary changes to their care delivery models.

It’s time to admit that we don’t yet know how this population health management thing is going to work and abandon the use of terminally vague generalizations. After all, once we do, we can focus on the answering our toughest questions — and that’s when we’ll begin to make real progress.

VA (Veteran’s Administration) Chooses Cerner EHR

Posted on June 5, 2017 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.

Some really big news just dropped from the VA Secretary, Dr. David J. Shulkin, that the VA has selected Cerner as their EHR replacement to VistA. You can see the full press release at the bottom of this email which outlines the VA Secretary’s reasoning for going with Cerner and the expedited process.

Without getting too much into the details of government procurement, the VA secretary has decided to use a “Determination and Findings” or “D&F” that allows him to avoid the government requirement for a full and open EHR selection and instead be able to solicit the EHR from Cerner directly. I’m pretty sure this will have many of the VistA and even the Epic people up in arms. We may even see some lawsuits out of it, but I don’t expect they’ll go anywhere. Of course, I think most of the VistA people knew this was coming ever since the VA secretary said they’d be pursuing a commercial EHR.

I think most people in the industry thought that the VA would and should go with Cerner for their EHR once the DoD chose Cerner and has since started implementing the Cerner Millennium EHR in what is now known as MHS GENESIS. The only naysayers suggested that the VA might choose Epic over Cerner just because they wanted to be different. That always seemed like a bit of a stretch to me, but it is government and so you can never know what to expect.

You can read the full press release below, but the reasons for choosing Cerner are pretty clear. The release does say that the VA will have its own instance of Cerner. So, they’ll still have to build interoperability between the DoD implementation of Cerner and the VA implementation of Cerner. This isn’t really a surprise when you think about their unique needs and the size of their implementations. Watch for the Cerner interoperability chart to go through the roof once they start sharing records between the DoD and VA.

I also found it interesting to note that the VA has a lot of community partners who are on other EHR platforms. We’ll see how interoperability goes for them. I expect they’ll likely use the standard interoperability options that are out there today.

The VA Secretary did note the concern of many VistA users when he said that “In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work. And our work will help DoD in turn.” I know many VistA fans who suggested that Cerner and Epic were way behing VistA in many areas and so moving to either commercial EHR would be a frustrating thing for many VA VistA users. We’ll see how well the VA Secretary can incorporate their current IT innovation into Cerner. I expect this will be an extremely hard challenge.

Not being an expert on government procurement, I’m interested to know how the VA will handle the rest of the procurement process. If you remember, the DoD’s massive EHR contract was really led by Leidos and not Cerner. Of the $9 billion contract, there were estimates that Cerner would only see $50-100 million per year of the $9 billion. The VA announcement only talks about a contract with Cerner for their EHR. Will they have to do an open bid process for all the services that Leidos and their rainbow of other partners are providing the Cerner DoD implementation?

Those are some initial high level views on this big announcement. What do you think of the announcement? Any other details I missed? Any other questions you have about it?

VA Press Release on Selection of Cerner EHR:

Today U.S. Secretary of Veterans Affairs Dr. David J. Shulkin announced his decision on the next-generation Electronic Health Record (EHR) system for the Department of Veterans Affairs (VA) at a news briefing at VA headquarters in Washington.

Secretary Shulkin’s full statement is below.

I am here today to announce my decision on the future of the VA’s Electronic Health Record system, otherwise known as EHR.

I wanted to say at the outset that from the day he selected me for this position, the President made clear that we’re going to do things differently for our Veterans, to include in the area of EHR.

I had said previously that I would be making a decision on our EHR by July 1st, and I am honoring that commitment today.

The health and safety of our Veterans is one of our highest national priorities.

Having a Veteran’s complete and accurate health record in a single common EHR system is critical to that care, and to improving patient safety.

Let me say at the outset that I am extremely proud of VA’s longstanding history in IT innovation and in leading the country in advancing the use of EHRs.

  • It was a group of courageous VA clinicians that began this groundbreaking work in the basements of VA’s in the 1970’s that led to the system that we have today, known as the Veterans Health Information Systems and Technology Architecture, or VistA.
  • It has been this system that led to the incredible achievements made by VA clinicians and researchers and resulted in VA’s ability to perform as well or better than the private sector in patient safety and quality of care.

That said, our current VistA system is in need of major modernization to keep pace with the improvements in health information technology and cybersecurity, and software development is not a core competency of VA.

I said recently to Congress that I was committed to getting VA out of the software business, that I didn’t see remaining in that business as benefitting Veterans.  And, because of that, we’re making a decision to move towards a commercial off-the-shelf product.

I have not come to this decision on EHR lightly.

I have reviewed numerous studies, reports and commissions, on this topic, including the recent commission on care report.

  • I’ve spent time talking with clinicians, and I use our legacy VistA system myself as a current practicing VA physician.
  • We have consulted with Chief Information Officers from around the country, and I’ve met personally with CEO’s from leading health systems to get their own thoughts on the best next-generation EHR for VA.
  • We’ve studied reports from management consulting companies and from the GAO and the IG on VA’s IT systems.
  • I can count no fewer than 7 Blue Ribbon Commissions, and a large number of congressional hearings that have called for VA to modernize its approach to IT.

At VA, we know where almost all of our Veteran patients is going to come from — from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years — from all the way back in 2000 — to work more closely on EHR issues.

To date, VA and DoD have not adopted the same EHR system. Instead, VA and DoD have worked together for many years to advance EHR interoperability between their many separate applications — at the cost of several hundred millions of dollars — in an attempt to create a consistent and accurate view of individual medical record information.

While we have established interoperability between VA and DOD for key aspects of the health record, seamless care is fundamentally constrained by ever-changing information sharing standards, separate chains of command, complex governance, separate implementation schedules that must be coordinated to accommodate those changes from separate program offices that have separate funding appropriations, and a host of related complexities requiring constant lifecycle maintenance.

And the bottom line is we still don’t have the ability to trade information seamlessly for our Veteran patients and seamlessly execute a share plan of acre with smooth handoffs.

Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems.

For these reasons, I have decided that VA will adopt the same EHR system as DoD, now known as MHS GENESIS, which at its core consists of Cerner Millennium.

VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems.

It’s time to move forward, and as Secretary I was not willing to put this decision off any longer.  When DoD went through this acquisition process in 2014 it took far too long.  The entire EHR acquisition process, starting from requirements generation until contract award, took approximately 26 months.

We simply can’t afford to wait that long when it comes to the health of our Veterans.

Because of the urgency and the critical nature of this decision, I have decided that there is a public interest exception to the requirement for full and open competition in this technology acquisition.

Accordingly, under my authority as Secretary of Veterans Affairs, I have signed what is known as a “Determination and Findings,” or D&F, that is a special form of written approval by an authorized official that is required by statute or regulation as a prerequisite to taking certain contract actions.

The D&F notes that there is a public interest exception to the requirement for full and open competition, and determines that the VA may issue a solicitation directly to Cerner Corporation for the acquisition of the EHR system currently being deployed by DoD, for deployment and transition across the VA enterprise in a manner that meets VA needs, and which will enable seamless healthcare to Veterans and qualified beneficiaries.

Additionally we have looked at the need for VA to adopt significant cybersecurity enhancements, and we intend to leverage the architecture, tools and processes that have already been put in place to protect DoD data, to include both physical and virtual separation from commercial clients.

This D&F action is only done in particular circumstances when the public interest demands it, and that’s clearly the case here.  Once again, for the reasons of the health and protection of our Veterans, I have decided that we can’t wait years, as DoD did in its EHR acquisition process, to get our next generation EHR in place.

Let me say what lies ahead, as this is just the beginning of the process.

  • VA has unique needs and many of those are different from the DoD.
  • For this reason, VA will not simply be adopting the identical EHR that DoD uses, but we intend to be on a similar Cerner platform.
  • VA clinicians will be very involved in how this process moves forward and in the implementation of the system.
  • In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work.  And our work will help DoD in turn.
  • Furthermore VA must obtain interoperability with DoD but also with our academic affiliates and community partners, many of whom are on different IT platforms.
  • Therefore we are embarking on creating something that has not been done before — that is an integrated product that, while utilizing the DoD platform, will require a meaningful integration with other vendors to create a system that serves Veterans in the best possible way.
  • This is going to take the cooperation and involvement of many companies and thought leaders, and can serve as a model for the federal government and all of healthcare.

Once again, I want to thank the President for his incredible commitment to helping our Veterans and his support for our team here at the VA as we undertake this important work.

This is an exciting new phase for VA, DOD, and for the country.  Our mission is too important not to get this right and we will.

UCHealth Adds Claims Data To Population Health Dataset

Posted on April 24, 2017 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 Colorado-based health system is implementing a new big data strategy which incorporates not only data from clinics, hospitals and pharmacies, but also a broad base of payer claim data.

UCHealth, which is based in Aurora, includes a network of seven hospitals and more than 100 clinics, caring collectively for more than 1.2 million unique patients in 2016. Its facilities include the University of Colorado Hospital, the principal teaching hospital for the University of Colorado School of Medicine.

Leaders at UCHealth are working to improve their population health efforts by integrating data from seven state insurers, including Anthem Blue Cross and Blue Shield, Cigna, Colorado Access, Colorado Choice Health Plans, Colorado Medicaid, Rocky Mountain Health Plans and United Healthcare.

The health system already has an Epic EMR in place across the system which, as readers might expect, offers a comprehensive view of all patient treatment taking place at the system’s clinics and hospitals.

That being said, the Epic database suffers from the same limitations as any other locally-based EMR. As UCHealth notes, its existing EMR data doesn’t track whether a patient changes insurers, ages into Medicare, changes doctors or moves out of the region.

To close the gaps in its EMR data, UCHealth is using technology from software vendor Stratus, which offers a healthcare data intelligence application. According to the vendor, UCHealth will use Stratus technology to support its accountable care organizations as well as its provider clinical integration strategy.

While health system execs expect to benefit from integrating payer claims data, the effort doesn’t satisfy every item on their wish list. One major challenge they’re facing is that while Epic data is available to all the instant it’s added, the payer data is not. In fact, it can take as much as 90 days before the payer data is available to UCHealth.

That being said, UCHealth’s leaders expect to be able to do a great deal with the new dataset. For example, by using Stratus, physicians may be able to figure out why a patient is visiting emergency departments more than might be expected.

Rather than guessing, the physicians will be able to request the diagnoses associated with those visits. If the doctor concludes that their conditions can be treated in one of the system’s primary care clinics, he or she can reach out to these patients and explain how clinic-based care can keep them in better health.

And of course, the health system will conduct other increasingly standard population health efforts, including spotting health trends across their community and better understanding each patient’s medical needs.

Over the next several months, 36 of UCHealth’s primary care clinics will begin using the Stratus tool. While the system hasn’t announced a formal pilot test of how Stratus works out in a production setting, rolling this technology out to just 36 doctors is clearly a modest start. But if it works, look for other health systems to scoop up claims data too!