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Judy Calls Epic “Most Open System I Know”

After Zina Moukheiber from Forbes was declined an interview with Judy Faulkner, CEO of Epic, last year Judy decided to talk to Zina about Epic in this article “An Interview With The Most Powerful Woman In Health Care.” Zina does a nice job on the interview and raises some of the questions many people have about Epic. It’s worth a read if you like to follow the hospital EHR world.

Many people are likely going to latch on to Zina calling Judy Faulkner the “most powerful woman in health care.” I don’t think that’s really up for discussion. Judy is the most powerful woman in healthcare and so I’m really glad that Judy is starting to join the discussion about Epic and healthcare. She has an important voice in the discussion and we need her participation. Although, I’m sure she’ll hate being called a billionaire in the article. The reality is we don’t know how much Judy’s really worth until we know how much Epic is worth and I’m not sure Epic plans to go public anytime soon.

Semantics aside, the most important part of the interview was the discussion of Epic being a closed system to which Judy frankly replied, “We are the most open system I know because we’re built as a database management system, and database management systems need to allow their users to mold it to what they need.” I think she really believes that Epic is an open system and quite frankly there aren’t that many in healthcare she can look to that are more open. Sure, a number of EHR vendors have worked to be more open, but even they aren’t as open as many other non health IT software systems. Maybe Judy hasn’t looked at the APIs outside of healthcare.

The real disconnect I had when reading Judy’s thoughts on being open is her lack of understanding of how a truly open API works. In a well implemented API, you can allow any and all programmers to be able to build applications on top of your software without those programmers needing to read your code and study your internal software. I’m not saying you don’t want and need to have an application and verification process for those people who want to tap into your API. This can be part of the process, but a well implemented and documented API can be open to everyone interested in building on top of your software. The value Epic would receive from so many companies iterating and extending the core Epic functionality would be amazing.

The other facet of Epic openness discussed in the article was around interoperability. Judy offered these comments on Epic’s ability to share patient records:

As of March 2013, our customers exchanged 760,000 patient records per month; about one-third were with non-Epic systems. Based on the historical trajectory, we expect that we’re closer to exchanging approximately one million records per month. We are currently exchanging data with Allscripts, Cerner, Department of Defense, Veteran Affairs Administration, Social Security Administration, eHealth Exchange (formerly Nationwide Health Information Network), Greenway, MEDITECH, NextGen and others. We expect to be exchanging data soon with eClinicalWorks, General Electric, Surescripts, and others.

This sounds good on face, but lets consider how many records Epic is sharing. Let’s use the round number of 1 million patient records shared per month. The article says that Epic has about half of the US population on Epic, or about 150 million patients. That means that about 0.67% of Epic’s patient records are being shared.

I’m happy to applaud Epic for sharing 1 million records a month with so many different vendors. My only complaint is that they could do so much more. For example, if you can share records between Epic and Cerner now, does that work for all Epic hospitals or do you have to do the new integration with every hospital that says they want to share records with Cerner? If it was a turn key way to integrate with Cerner, I’m quite sure that instead of 1% of Epic’s patient records being shared we’d see tens of millions of patient records flowing where they needed to go.

Many might remember my surprise breakfast with Judy Faulkner at the CHIME Forum. From my personal experience, Judy is not the black widow that I’ve heard many portray her to be. In fact, I found her incredibly thoughtful, caring, and really interested in quality patient care. That’s why I hope Judy will see that she’s sitting on an opportunity to do so much more than she’s doing now. Although, it will take a shift in her understanding of what it means to be an open EHR. Right now it seems her mostly unfounded fears won’t let her see the possibilities.

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May 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

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Epic Module Targets Patients For Care Coordination

At Gundersen Lutheran Health System, executives have put together a program to target the 1 to 2 percent of those most likely to be hospitalized, seen in the emergency department or face other complications. To manage the program, the La Crosse, Wis.-based system is leveraging a feature of their Epic EMR which sifts out the patients most in need of additional care coordination, reports Health Data Management.

Gundersen Lutheran is targeting complex patients with its program, but not just those with medically-complex conditions. They’re also hoping to find patients who, while they might have simpler conditions, live alone or have trouble following sometimes difficult medical care plans.  The system is using the EMR first to identify the patients, then to treat them, according to Health Data Management.

To find patients in need of extra care coordination services, Gundersen is using a “tiered scoring” module built in to the Epic platform which includes one component for medical complexity and another to measure psycho-social issues. When clinicians want to refer a patient to the care coordination program, physicians use the Epic scoring tool to see if  the patient qualifies. Clinicians can also notify the care coordination team using the Epic system, in three clicks or less, noted Beth Smith, R.N., executive director of patient and family-centered care at the health system.

The patients identified by the scoring model as in need of extra care coordination are farmed out to a group of 22 nurses and social workers, whose job it is to monitor the care of these complex patients who are more likely to face adverse events.

The workload the care coordinators face is intense.  Typically, care managers are supervising some 1,700 patients each, who not only stay in touch with patients but also attend office visits and follow through with specialists.  Epic plays a role here too, however.  Care coordinators get a special tab in the Epic EMR which pulls key elements of the patient’s history into a single view,  making it easier to get a sense of the whole patient.  Epic also notifies them via a message in the system if a patient shows up in the ED.

According to Health Data Management, this program has helped stabilize hypertensive and diabetic patients, with just under half showing sustained improvements over a two-year period.

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May 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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Cleveland Clinic Brings Epic Smarts To NY Hospital Practices

The Cleveland Clinic is going the consulting route, this time around by working with the physician and specialty practices for a New York hospital to bring Epic up to speed.

Glens Falls is a 410-bed nonprofit which began implementing the Epic EMR in early 2012. The New York facility has 3,000 employees and 28 regional locations.

Apparently dissatisfied with its internal knowledge base on the subject, It’s now contracted with the Clinic’s MyPractice Healthcare Solutions (MPHS) to help deploy and optimize its rollout, reports the Cleveland Plain Dealer.

Among the Epic products installed at Glens Falls is “MyChart,” offering a clinical and billing records portal for patients, according to the Plain Dealer.

The Cleveland Clinic has had Epic in place for more than 10 years, making it one of the first healthcare systems in the country to install the vendor’s product. Having learned from that experience, Cleveland Clinic MPHS now brings project management and implementation expertise to other facilities.

I think this is an interesting business model for the Cleveland Clinic, and I’d be curious to see what other consulting agreements it has put into place. (So far I wasn’t able to turn up any others but my guess is that they exist.)

It seems to me that hospitals who have tamed Epic — Kaiser Permanente comes to mind — might very well go into this line of business, as the need is great. Not to mention that if I were making a decision as to who I’d hire to wire my medical practice into my hospital, a successful institution would have a very strong pitch to make.

Can any of you readers share other examples of hospitals/clinics who are turning their Epic experience into a consulting revenue stream?

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May 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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W. VA. Rolls Out Enhancements To VistA

Officials with the West Virginia bureau of behavior health and health facilities are putting some finishing touches on VistA installations cutting across the state, adding computerized laboratory information to a six-year-old implementation.

West Virginia officials have implemented Vista in seven communities, Modern Healthcare reports. Facilities include an acute-care hospital, two psychiatric hospitals, four long-term care hospitals, a nursing home and two ambulatory care clinics.  The facilities are all connected to a central database in Charleston via T1 lines.

The state has been working on contract with Medsphere Systems Corp. to install a VistA version known as FOIA VistA, a version in the public domain that can be obtained freely from the VA under the Freedom of Information Act, Modern Healthcare notes.

Though VistA itself is free, the state has spent heavily on installing it across the seven sites.  Since FY 2005, West Virginia has paid Medsphere $8.4 million for system implementation, development and support, and is contracted to pay the vendor $939,800 this year for support.

In addition to paying Medsphere a monthly fee for systems support, the state pays licensing fees to InterSystems, developer of Cache, a version of the MUMPS database and programming language. It also licenses Keane’s financial system, which interfaces with VistA.

West Virginia began looking at a common infrastructure for all of its facilities when HIPAA passed back in 1996, noting that the idea behind it was portability and accountability. Now state officials are glad they moved ahead. “It’s expensive,” but “in terms of satisfaction, I think we’d all agree it was well worth it,” deputy commissioner for administration Craig Richards told the magazine.

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May 7, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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Epic Installation Fuels Maine Controversy

Ordinarily, the fact that integrated delivery system MaineHealth had spent $150 million on an Epic EMR system wouldn’t excite a lot of comment.  After all, say what you like about Epic, it doesn’t come cheaply, and a $150 million install is at the low-ish end of what hospitals are spending to put the vendor’s system in place.

This time, though, the health system is taking fire from the community, in part because it’s decided to close 22-bed St. Andrews Hospital in Boothbay Harbor, reports EHR Intelligence. 

In an open letter published in the Boothbay Register, local selectman and St. Andrews Regional Task Force member Stuart Smith argues that the Epic install cost is “extremely high.”

Smith also notes that Maine Health has had a bad time with the installation, which was supposed to go live on December 1, 2012 and now looks as though it won’t go live until 2015.  As Smith sees it, a lot of money and time is being wasted on the Epic project:

Millions of dollars have been charged to member hospitals and staff time (salaries and mileage) over the past 2–3 years with no benefit. The system failure also adds operational costs going forward that were not planned for and regional consolidation of finance will now be delayed.

As things stand, Smith notes, the planned closure of St. Andrews is part of a larger shuffle moving urgent and emergency services around which has led to roughly $2 million in losses for the facility.

With St. Andrews wobbly, leaders are considering merging it with struggling Miles Memorial Hospital, a combination which could allow its owners to keep $5 million in federal reimbursement by keeping its critical access hospital designation.

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May 6, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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Survey: Confusion Slowing Meaningful Use Compliance

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).

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May 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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Is Epic Stifling Health IT Innovation?

In many ways and definitely based on the buzz, Epic is at the top of the hospital EMR market. According to one estimate, about 40 percent of the U.S. population has its medical information stored in an Epic EMR, a stunning number given the level of competition in the hospital EMR space.

The question is, what impact is that having on the EMR marketplace?  According to one piece posted this week by Medical Economics,  Epic may be stifling health IT innovation due to its nearly-unassailable market lead.

As readers probably know, Epic has established an empire built around antiquated technology (MUMPS), which essentially forces any company that hopes to interoperate to bear its MUMPS core in mind. We’re talking the blunted edge here.

Perhaps more importantly, now that Epic has such a dominant market share, if it chooses to keep a closed system in place, customers will only get what innovations are driven internally by Epic.  If hospitals want innovations emerging outside the Epic bubble, they’ll have to consider the staggering costs — in some cases in the hundreds of millions of dollars — of switching outright to another vendor. If that doesn’t stifle innovation I don’t know what does.

This situation hasn’t been lost on healthcare industry leaders, some of whom have begun to balk at Epic’s rise, Medical Economics reports.

As the piece notes, Epic has attracted outspoken critics that question whether Epic’s’ market dominance is bad for the health IT world as a whole. One of those critics is Paul Levy, former CEO of Beth Israel Deaconess Medical Center, who has taken shots at the EMR giant from his “Not Running A Hospital” blog.

Levy, who Medical Economics cites as one of Epic’s toughest opponents, has been known to compare customers’ relationship with Epic to Stockholm Syndrome, a condition occurring when hostages begin to sympathize and identify with their captors.

All that being said, at the  moment, there’s little critics can do to change Epic’s business practices or development plans. Perhaps the Federal Trade Commission will step in at some point if it appears to staff there that Epic’s market control is anti-competitive.   In the mean time, though, Epic seems to have a lock on the hospital marketplace — and a disproportionate role in shaping the future of EMRs generally.

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April 30, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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EMRs Have Certifications Yanked

A California EMR developer has become the first to have its certification for Meaningful Use taken away by the ONC.

EHRMagic-Ambulatory and EHRMagic-Inpatient, both of which were developed by Santa Fe Springs, Calif.-based EMRMagic, failed to meet certification requirements, reports EMR Thoughts.

The de-certification process began when ONC and ONC-authorized certification body InfoGard Laboratories were notified that the EHRMagic products didn’t meet Meaningful Use certification requirements.

InfoGard Laboratories analyzed the information sent along with the notification and contacted the vendor. It then began the process of ONC-ACB required surveillance activities, according to HIN. At that point, InfoGard decided to test the two products for compliance with certain requirements.  EHRMagic’s products were then retested, and failed to meet criteria for Meaningful Use certification.

Fortunately for the company’s customers, no providers had yet attempted Meaningful Use attestation using these products. One can only imagine the frustration they would have faced if they attempted to attest in good faith and found out that the EMR product they were using wasn’t capable of supporting MU certification.

I’m left wondering whether providers would have grounds for a lawsuit against the offending vendor if they attempted certification with a product that didn’t support Meaningful Use, particularly if the vendor had any idea that this might be the case.

Realistically, it seems likely at some point in the future, some provider will be left high and dry by a certified product that shouldn’t have gotten the go-ahead.  My guess is that things will get nasty pretty quickly!

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April 29, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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ONC Proposes New EMR Vendor Fee

It looks like federal budget balancing fervor could soon have an impact on EMR vendors (See also this post on EHR Incentive and Sequestration). As part of President Obama’s current budget proposal, the ONC is suggesting that health IT vendors pay about $1 million in fees to help pay for its certification and standards work, reports Modern Healthcare. Collection of the fee, which would probably begin late in the fiscal year, would be collected by ONC-Authorized Certification Bodies.

The proposal is part of the ONC’s section of the overall budget proposal released this week by the Obama Administration. The president’s budget is already causing a stir in healthcare circles outside of IT, as it calls for $5.6 billion in Medicare payment cuts for fiscal 2014.

So what has caused the ONC to look for fresh revenue?  One key reason is that ONC’s $2 billion appropriation from ARRA is scheduled to expire at the end of fiscal 2013, and the agency needs new funds to stay on its feet.

By its logic, the improved testing and certification programs will help vendors save time and money, which justifies their kicking in some money to support the process, Modern Healthcare says.

Not only would the funds gear up the certification program, it would also help maintain ONC’s Certified Health IT product list, as well as its development work around standards for interoperability and policy docs related to HIT certification, the magazine reports.

Without a doubt, the proposed fees will make vendors unhappy, but as I see it they’re just not large enough to justify a major uprising by the health IT community.  The only real issue I see is whether the fees are going to be proportionate to the size of the vendor; if I were a small ambulatory player I’d be quite upset if I paid the same fee as Epic or Cerner.

Otherwise, this fee seems like a relatively small issue, particularly if ONC does a good job of using the funds to improve the certification program. Let’s hope it works out that way.

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April 12, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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CommonWell Alliance Goals Challenged By ONC

As virtually everyone in health IT knows, HIMSS saw the dawning of a new EMR vendor alliance which proposes to make health data exchange simpler.  The group, the CommonWell Alliance, includes McKesson, Cerner, Allscripts, Greenway and athenahealth, plus McKesson’s connectivity business RelayHealth.

Now that the PR fairy dust has settled and we’re talking serious business, it’s a good time to consider exactly what these vendors hope to accomplish, as we’re talking about enough vendor muscle to have a serious impact on the way health data is shared.

This week, ONC released a report doing just that, according to a piece in Government Health IT.  At a meeting of the Health IT Policy Committee on April 3, National Coordinator for Health Information Technology Farzad Mostashari, MD and other committee members discussed the report, which raised some hard questions about the Alliance.

According to Government Health IT, the report outlined the following as CommonWell’s chief goals:

  • Enabling providers to unambiguously identify patients – but not with a national patient identifier;
  • Providing a way to match patients with their healthcare records as they transition through care facilities;
  • Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
  • Enabling patients to manage consent and authorization;
  • Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
  • Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
  • Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.

Unlike most standards-setting efforts, members of the group are going to have to pay if they want to participate, a nice little detail that wasn’t made clear when CommonWell was announced.

Though it will be at least a year before CommonWell pilots its approach, members of the Committee are quite appropriately wondering now about the impact of such an effort.

Dr. Mostashari argued that the key question is whether the service will work as an optional overlay across a regional exchange, or whether it requires exclusive participation. Other committee members agreed.

The bottom line for committee members, Government Health IT reports, is that they’re willing to take a wait-and-see approach. As for us out here in the peanut gallery, I believe we should challenge the heck out of this thing.

Members of the Health IT Policy Committee are well advised to wonder whether this coming together of powerful HIT vendors could undermine broader efforts to foster interoperability. There’s a lot to look into here, even if the allmighty Epic never joins.

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April 8, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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