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Boston Children’s Benefits From the Carequality and CommonWell Agreement

Posted on February 3, 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.

Recently two of the bigger players working on health data interoperability – Carequality and the CommonWell Health Alliance – agreed to share data with each other. The two, which were fierce competitors, agreed that CommonWell would share data with any Carequality participant, and that Carequality users would be able to use the CommonWell record locator service.

That is all well and good, but at first I wasn’t sure if it would pan out. Being the cranky skeptic that I am, I assumed it would take quite a while for the two to get their act together, and that we’d hear little more of their agreement for a year or two.

But apparently, I was wrong. In fact, a story by Scott Mace of HealthLeaders suggests that Boston Children’s Hospital and its physicians are likely to benefit right away. According to the story, the hospital and its affiliated Pediatric Physicians Organization at Children’s Hospital (PPOC) will be able to swap data nicely despite their using different EMRs.

According to Mace, Boston Children’s runs a Cerner EMR, as well as an Epic installation to manage its revenue cycle. Meanwhile, PPOC is going live with Epic across its 80 practices and 400 providers. On the surface, the mix doesn’t sound too promising.

To add even more challenges to the mix, Boston Children’s also expects an exponential jump in the number of patients it will be caring for via its Medicaid ACO, the article notes.

Without some form of data sharing compatibility, the hospital and practice would have faced huge challenges, but now it has an option. Boston Children’s is joining CommonWell, and PPOC is joining Carequality, solving a problem the two have struggled with for a long time, Mace writes.

Previously, the story notes, the hospital tried unsuccessfully to work with a local HIE, the Mass Health Information HIway. According to hospital CIO Dan Nigrin, MD, who spoke with Mace, providers using Mass Health were usually asked to push patient data to their peers via Direct protocol, rather than pull data from other providers when they needed it.

Under the new regime, however, providers will have much more extensive access to data. Also, the two entities will face fewer data-sharing hassles, such as establishing point-to-point or bilateral exchange agreements with other providers, PPOC CIO Nael Hafez told HealthLeaders.

Even this step upwards does not perfect interoperability make. According to Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, providers leveraging the CommonWell/Carequality data will probably customize their experience. He contends that even those who are big fans of the joint network may add, for example, additional record locator services such as one provided by Surescripts. But it does seem that Boston Children’s and PPOC are, well, pretty psyched to get started with data sharing as is.

Now, back to me as Queen Grump again. I have to admit that Mace paints a pretty attractive picture here, and I wish Boston Children’s and PPOC much success. But my guess is that there will still be plenty of difficult issues to work out before they have even the basic interoperability they’re after. Regardless, some hope of data sharing is better than none at all. Let’s just hope this new data sharing agreement between CommonWell and Carequality lives up to its billing.

Health IT Preserves Idaho Hospital’s Independence

Posted on February 1, 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.

Most of the time, when I write about hospital IT adoption, I end up explaining why a well-capitalized organization is going into the red to implement its EMR. But I recently found a story in RevCycle Intelligence in which a struggling hospital actually seems to have benefitted financially from investing in IT infrastructure. According to the story, a 14-bed critical access hospital in Idaho recently managed to stave off a forced merger or even closure by rolling out an updated EMR and current revenue cycle management technology.

Only a few years ago, Arco, Idaho-based Lost Rivers Medical Center was facing serious financial hurdles, and its technology was very outdated. In particular, it was using an EMR from 1993, which was proving so inflexible that the claims stayed in accounts receivable for an average of 108 days. “We didn’t have wifi,” CEO Brad Huerta told the site. “We didn’t have fiber. We literally had copper wires for our phone system…we had an EMR in a technical sense, but nobody was using it. It was a proverbial paperweight.”

Not only was the cost of paying for upgrades daunting, the hospital’s location was as well. Arco is a “frontier” location, making it hard to recruit IT staffers to implement and maintain infrastructure, staff and servers, the story notes. Though “fiercely independent,” as Huerta put it, it was getting hard for Lost Rivers to succeed without merging with a larger organization.

That being said, Huerta and his team decided to stick it out. They feared diluting their impact, or losing the ability to offer services like trauma care and tele-pharmacy, if they were to merge with a bigger organization.

Instead of conceding defeat, Huerta decided to focus on improving the hospital’s revenue cycle performance, which would call for installing an up-to-date EMR and more advanced medical billing tools. After the hospital finished putting in fiber in its area, Lost Rivers invested in athenahealth’s cloud-based EMR and medical billing tools.

Once the hospital put its new systems in place, it was able to turn things around on the revenue cycle front. Total cash flow climbed rapidly, and days in accounts receivable fell from 108 to 52 days.

According to Huerta, part of the reason the hospital was able to make such significant improvements was that the new systems improved workflow. In the past, he told RevCycle Intelligence, providers and staff often failed to code services correctly or bill patients appropriately, which led to financial losses.

Now, doctors chart on laptops, tablets or even phones while at the patients’ bedside. Not only did this improve coding accuracy, it cut down on the amount of time doctors spend in administrative work, giving them time to generate revenue by seeing additional patients.

What’s more, the new system has given Lost Rivers access to some of the advantages of merging with other facilities without having to actually do so. According to the story, the system now connects the critical access hospital with larger health systems, as the athenahealth system captures rule changes made by the other organization and effectively shares the improvements with Lost Rivers. This means the coding proposed by the system gradually gets more accurate, without forcing Lost Rivers to spend big bucks on coding training, Huertas said.

While the story doesn’t say so specifically, I’m sure that Lost Rivers is spending a lot on its spiffy new EMR and billing tech, which must have been painful at least at first. But it’s always good to see the gamble pay off.

Health System Pays Docs To Use Cerner EHR

Posted on November 7, 2016 I Written By

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

Typically, we cover US-based stories in this blog, but the following is just too intriguing to miss. According to a Vancouver newspaper, an area hospital system agreed to pay physicians a daily fee to use its unpopular Cerner EHR, positioning the payments as compensation for unpaid overtime spent learning the system.

The Times Colonist is reporting that local hospital system Island Health has offered on-call physicians at its Nanaimo Regional General Hospital $260 a day, and emergency department physicians up to $780 a day, to use its unpopular Cerner system.

The newspaper cites a memo from hospital chief medical officer and executive vice president Dr. Jeremy Etherington, which says that the payment was in recognition of “the extra burden the new electronic health record has placed on many physicians during the rollout phase” of the new EHR.

In 2013, Island Health (which is based in British Columbia, Canada) signed a 10 year, $50 million deal with Cerner to implement its platform across its three hospitals. More recently, in March of this year, Island Health’s three facilities went live on the Cerner platform.

Within weeks, physicians at Nanaimo Regional Hospital were flooding executives with complaints about the new platform, which they claimed we randomly lost, buried or changed orders for drugs and diagnostic tests. Some physicians at the hospital reverted to using pen and paper to complete orders.

Not long after, physicians signed a petition asking the health system to stop further implementation, citing safety and workability concerns, but executives still moved forward with the rollout.

Neither the newspaper article nor other reports could identify how many physicians accepted the offer from Island Health. Also, the health systems management hasn’t shared how it picked doctors who were eligible for the payout, and what criteria it used to determine the size of the higher emergency department physician payouts. However, according to a Nanaimo physician and medical staff member quoted by Becker’s Health IT & CIO Review quotes, execs structured the payments to reflect the unpaid overtime doctors put in to learn the system.

As for the claims that the Cerner system was causing clinical problems and even perhaps endangering patients, that issue is still seemingly unresolved. In late July, British Columbia Minister of Health Terry Lake apparently ordered a review of the Cerner system, but results of that review do not appear to be available just yet.

It’s not clear whether the payments bought Island Health enough goodwill to mollify the bad feelings of doctors who didn’t receive one of these payments, nor whether those who are being paid will stay bought. And that’s the real question here. Call the payments a publicity stunt, an attempt at fairness or cynical political strategy, they may not be enough to get physicians onto the system if they are convinced it doesn’t work. I guess we’ll have to wait and see what happens.

Should Hospitals Track ED “Frequent Fliers” In Their EMR?

Posted on October 28, 2016 I Written By

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

Particularly as value-based reimbursement falls into place, hospitals have good reasons to track emergency department utilization across populations. As with readmissions, ED visit rates and diagnoses can tell you something valuable about patients’ conditions and the extent to which they are managing those conditions, as well.

However, tracking individual ED use, especially by behavioral health patients, may result in less-desirable consequences. In fact, according to a viewpoint article published recently in JAMA, adding icons or symbols to the records of patients who are considered to be “superusers” or “frequent fliers” can stigmatize patients and create bias against them.

“A pejorative branding, ‘frequent flyers’ are often assumed to be problem patients. In psychiatric settings, these patients are sometimes said to be ‘borderlines,’ ‘drug seekers,’ ‘malingerers,’ or ‘treatment resistant,’ according to authors Michelle Joy, MD, Timothy Clement, MPH and Dominic Sisti, PhD.

The researchers note that at least one EMR offers the capacity to insert an airplane icon beside the patient’s name, and not only that, to display the icon in different colors depending on where the patient falls among the high using population. But they consider this to be ethically and clinically inappropriate.

For one thing, they say, uses such an icon ‘encourages the use of disrespectful and stigmatizing terminology.’ What’s more, the use of such labels may change the clinician’s initial interactions with the patient in a way that affects their judgment negatively, and may subject the patient to the risk of a poor outcome from their care.

Not only that, they point out, while it might be useful to know that a patient presents in the ED frequently, determining why this happens can only take place if the clinician does a deeper dive into their utilization history. And slapping a high utilization icon the patient record actually discourages such in-depth examination, they contend.

On top of all that, if the patient is assumed to be visiting the ED frequently for largely psychiatric reasons, “diagnostic overshadowing” may occur, to the patient’s detriment. For example, they note, if a patient has a co-occurring mental illness in a condition such as cardiovascular disease, the patient is less likely to receive adequate medical care than patients without a medical condition, as the psych diagnosis overshadows their medical problems.

To avoid creating signifiers like the icon, which may build in the makers’ implicit biases, EMRs and behavioral health apps should be filled and tested in collaboration with patients, consumers, ethicists and other parties sensitive to the broader ramifications of using such language and iconography, the authors suggest.

In the meantime, readers of this publication might want to stop and think if there are any other ways in which the health IT systems they design and use reflect other unhelpful biases. While placing a frequent flyer icon beside a patient’s name seem like a particularly egregious instance — or does to me anyway – there may be subtler ways in which your HIT systems foster negative or inappropriate assumptions. And it’s good to dig those out and examine them. After all, nobody wins when patients fail to get the care they need.

Access To Electronic Health Data Saves Money In Emergency Department

Posted on October 24, 2016 I Written By

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

A new research study has found that emergency department patients benefit from having their electronic health records available when they’re being treated. Researchers found that when health information was available electronically, the patient’s care was speeded up, and that it also generated substantial cost savings.

Researchers with the University of Michigan School of Public Health reviewed the emergency department summaries from 4,451 adult and pediatric ED visits for about one year, examining how different forms of health data accessibility affected patients.

In 80% of the cases, the emergency department had to have all or part of the patient’s medical records faxed to the hospital where they were being treated. In the other 20% of the cases, however, where the ED staff had access to a patient’s complete electronic health record, they were seen much more quickly and treatment was often more efficient.

Specifically, the researchers found that when information requests from outside organizations were returned electronically instead of by fax, doctors saw that information an hour faster, which cut a patient’s time in the ED by almost 53 minutes.

This, in turn, seems to have reduced physicians’ use of MRIs, x-rays and CT scans by 1.6% to 2.5%, as well as lowering the likelihood of hospital admission by 2.4%. The researchers also found that average cost for care were $1,187 lower when information was delivered electronically.

An interesting side note to the study is that when information was made available electronically on patients, it was supplied through Epic’s Care Everywhere platform, which is reportedly used in about 20% of healthcare systems nationwide. Apparently, the University of Michigan Health System (which hosted the study) doesn’t belong to an HIE.

While I’m not saying that there’s anything untoward about this, I wasn’t surprised to find principal author Jordan Everson, a doctoral candidate in health services at the school, is a former Epic employee. He would know better than most how Epic’s health data sharing technology works.

From direct experience, I can state that Care Everywhere isn’t necessarily used or even understood by employees of some major health systems in my geographic location, and perhaps not configured right even when health systems attempt to use it. This continues to frustrate leaders at Epic, who emphasize time and again that this platform exists, and that is used quite actively by many of its customers.

But the implications of the study go well beyond the information sharing tools U-M Health System uses. The more important takeaway from the study is that this is quantitative evidence that having electronic data immediately available makes clinical and financial sense (at least from the patient perspective). If that premise was ever in question, this study does a lot to support it. Clearly, making it quick and easy for ED doctors to get up to speed makes a concrete difference in patient care.

Should You Buy Pop Health Tools And EMRs From One Vendor?

Posted on October 17, 2016 I Written By

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

According to a new story appearing in HealthITAnalytics, EMR vendors are increasingly moving into the population health management space. In fact, according to an IDC Research market report featured in the story, the lines between the EMR and population health management marketplaces are beginning to blur, with vendors offering products tackling both documentation and patient management.

While this is not news to anyone who’s attended a major industry tradeshow in the last few years, the extent of the transition might be. Apparently, half of the top population health management vendors featured by IDC – including athenahealth, eClinicalWorks and Allscripts — also offer EMR platforms. (According to HealthITAnalytics, other pop health vendors identified as leaders by IDC include Wellcentive, Medecision, Optum and IBM Phytel.)

Cynthia Burghard, Research Director with IDC Health Insights, says that providers want to integrate patient management and big data analytics to support their ACO deals and meet tregulatory requirements. In an IDC press release, she notes that providers need to manage both clinical and financial outcomes to survive under value-based reimbursement.

While all of this makes sense to me on paper, I’d like to raise a question here. Does buying both your EMR and your pop health tool from the same vendor have a meaningful downside? I’d argue that it might.

Yes, from a high level, buying an EMR and population health management engine from the same vendor is a good idea. In theory, the two are likely to work together more effectively than two platforms from two separate vendors, as there’s unlikely to be any conflict between the purposes of the EMR and the purposes of the population health tool.

But in practice, it’s worth bearing in mind that we haven’t yet evolved a standard feature set or business model for managing patients at the population level (though you might be interested in some of these emerging best practices). So this is a far bigger risk than buying, for example, a practice management tool and an EMR from the same vendor — after all, practice management software has been around long enough that it’s fairly standardized.

On the other hand, if you buy a population health tool and an EMR from, say, Allscripts, you’re buying not only technology but their view of how population health management should be done. And the two platforms are somewhat, for lack of a better word, inbred if they try to cover your entire scope of patient management. Whatever blind spots the EMR may have, the pop health management platform may have as well.

I guess what I’m trying to say here is that while it makes great business sense for the vendors to offer both EMR and pop health products, it’s not necessarily in the provider’s interests to pile both of those products onto their infrastructure. At this stage, I’d argue, it’s worth preserving your flexibility, even if you spend more or have to work harder to develop the business logic you need on the population health side.

But I’m willing to change my mind. Readers, what do you think?

Cerner Tops List Of Hospital Vendors For Medicare EHR Incentive Program

Posted on September 28, 2016 I Written By

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

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

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

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

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

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

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

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

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

Bad Handwriting Could Cost a Doctor His License

Posted on September 16, 2016 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

I admit that I don’t have very good handwriting. My signature is no better, and often leads people to ask if I am a doctor. Because it is commonly known that doctors don’t excel at handwriting skills. Thankfully, I rarely hand-write anything anymore. With computers, I can write quickly while still producing a result that is easy to read.

One benefit of an EHR solution is that we don’t have to worry about deciphering handwritting! But for one Nevada doctor, poor penmanship may lead to the loss of his medical license!

Read this story in the Review Journal for more information or this excerpt of the situation below:

The Nevada State Medical Board has formally threatened to revoke the medical license of Dr. James Gabroy, a 69-year-old Henderson internist who has never had malpractice or professional incompetence problems, nor has he ever had sexual misconduct, patient abandonment or fraudulent billing issues.

why is the board taking action against Gabroy — punishment ranges from a $5,000 fine to license revocation — with a Sept. 28 hearing scheduled in Reno?

His handwriting.

Citing confidentiality, Ed Cousineau, the board’s executive director, won’t stray far from the Oct. 23, 2015, board complaint that alleges the medical records of three unnamed patients were illegible, inaccurate and incomplete.

Are we heading for an environment where you’ll have to have an EHR in order to have a medical license?

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Study: Hospital EMR Rollouts Didn’t Cause Patient Harm

Posted on September 14, 2016 I Written By

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

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

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

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

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

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

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

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

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

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

Is It a Hot or Cold Hospital EHR Buying Market? – Response

Posted on August 15, 2016 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

This article is in response to John Lynn’s recent posting, Is It a Hot or Cold Hospital EHR Buying Market?

In his recent posting, John Lynn asked the question “Is it a Hot or Cold Hospital EHR Buying Market?”. In it he highlights a recent KLAS report that over 490 hospitals, a staggering 10% of the entire market, were involved in an EHR decision in 2015. After reading his posting, I wanted to take a moment to share my observations.

2015 was indeed an amazing year for EHR sales, partly driven by the pending sunset date of Mckesson Horizon forcing many customers to switch EHR solutions. Some of those customers are going to Paragon, but many more purchased or are evaluating other solutions. During a recent trip to Epic University, I was surprised to find that nearly half of the attendees of the classes were hospitals switching from Mckesson Horizon to Epic – and all had just recently completed their purchases (late 2015/early 2016) and were facing the same live dates of late 2017/early 2018.

Hospitals who have purchased and implemented Epic or Cerner are very unlikely to make a change. Regardless of which solution is preferred, the investment in these solutions and the level of effort required to switch from one to another is so high, that it would take a significant triggering event for a hospital to make that change. Therefore it is likely that customers on these solutions will not be making a change in the near future.

However, KLAS reports that nearly 40% of MEDITECH customers would change EMR’s if they could, and that Paragon customers also report unrest. Therefore in addition to the shrinking number of those that have not implemented a viable EHR solution, the possibility that there will be a wave of customers switching from one of these solutions to Epic or Cerner remains a consideration. There is also the question of how the recent spin-off of Mckesson’s software division will impact the future of Paragon. If Paragon were discontinued or sold, it could lead to another explosion of EHR decisions. If instead there was a significant investment in the solution, it could become a more viable alternative as customers look to switch from one EHR to another.

I suspect that 2016 will be another strong year from EHR sales in general and for Epic and Cerner in particular. Beyond that, much will depend on the strength of the other solutions and which ones break out into the top tier. Regardless, the recent explosion of EHR sales and the rush to replace Horizon will in many cases lead to minimized installs – where the bare minimum work was completed and there is significant opportunity to improve business processes, implement new modules, and roll out advanced functionality within those solutions. As a result I believe that within a few years, the market will be more stabilized with fewer customers switching solutions, and instead focusing on maximizing what they have.

Unless another player comes in and disrupts the marketplace or a significant shift in the industry creates a reason to make a change yet again…

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.