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Has Epic Grown Too Big, Too Fast?

Posted on November 8, 2013 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.

We’ve written a lot of posts over the years about some of the challenges that Epic has faced as it’s grown its EHR business. In fact, Anne Zieger’s post yesterday about a Hospital Credit Rating Lowered due to their Epic Project is one example. However, I was really struck by this reader submitted article on HIStalk.

The article is written by a “Long-Time Epic Customer”. You don’t get the sense that this customer is bitter or has any real dog in the fight. In fact, if anything this customer seems to have a love for Epic and they want Epic to win the EHR battle. However, they’re concerned by the changes that they’ve seen in Epic as its grown. His a paragraph from the article:

We installed Epic years ago, but have seen a vast difference between our prior experience and a recent rollout of newer products. The method where time was taken to help us build our own system has been replaced by a rushed, prefab Model system installed by staff where even the advisers and escalation points at Epic have little knowledge of their applications. Epic has always had newer people, but it was much more common to have advisers during the install who did have experience to watch for pitfalls.

The writer then goes on to describe how Epic seems to be investing in the wrong things. “We’re getting answers, solutions, fixes, and reports slower than ever.”

I think the reason many of things really struck a chord with me is that they’re matching up with many of the things I’ve seen and heard. Based on some real anecdotal things I’ve heard I won’t be surprised if Judy decides to get out of the day to day work at Epic sometime soon. We’ll see how it plays out, but an Epic without Judy at the helm will be quite different.

Epic Implementation Problems Lead To Lower Hospital Credit Rating

Posted on November 7, 2013 I Written By

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

Of late, stories have begun to crop up about troubled Epic implementations and the financial problems that these shaky implementations can cause. In fact, we’re aware of at least one Epic investment which may have led to the departure of a CIO from a Maine hospital.

Now, we’re told that a troubled Epic implementation has led to the lowering of a hospital’s credit rating. Standard & Poor’s has lowered Winston-Salem, NC-based Wake Forest Baptist Medical Center’s debt from AA- to A+, primarily due to the problems Wake Forest has had in rolling out Epic, according to Becker’s Hospital Review.

According to a statement from Wake Forest, the EMR implementation had a bigger impact on the hospital’s finances and operations than it had anticipated, leading to poorer overall fiscal performance than expected for 2013. Earlier this year, the CIO for Wake Forest resigned in the wake of the Epic debacle.

Wake Forest spent about $13.3 million to bring Epic on board, and roughly $8 million on Epic-related expenses, but that doesn’t seem to have been the main reason the install caused financial problems. We know from a report in the Winston-Salem Journal that since the Epic rollout, the hospital said that it had lost $26.6 million in margin due to volume disruption caused by Epic-related problems.

The Epic implementation wasn’t the only reason for the downgrade. It came partly due to cuts in NIH research funding, lower volume growth, a lower provider tax and sequestration cuts, according to hospital CFO and vice president for finance Edward Chadwick. But clearly, the disruptions caused by the Epic install have been major.

S&P did show Wake Forest some mercy, changing its financial outlook from “negative” to “stable.”  The agency is predicting that the hospital should rebound financially in 2014 as the disruptive effect of the Epic install decreases.

EMRs Now A Patient Draw At Hospitals

Posted on November 5, 2013 I Written By

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

In the past, the mere fact that a hospital had adopted an EMR wasn’t news in and of itself — at least not to a hospital’s current and potential patients. After all, hospitals didn’t let everyone know when they upgraded its network or added backup storage facilities, right?

These days, however, EMR adoption has become a consumer attraction, enough so that hospitals announce their go-live with press releases and public spectacle.

One example comes from Colorado Springs, CO-based Memorial Hospital, which is part of the University of Colorado Health system. Memorial, which launched its EMR this past weekend, spent $30 million on an Epic system.

The launch comes complete with a portal, My Health Connection, allowing  patients to access their medical records, request appointments online, communicate with doctors via secure e-mail and receive test results. The portal is also intended to make it easier for doctors throughout the UCHealth system to access patient records.

The Memorial press release announcing this milestone lumps the Epic implementation in with a laundry list of accomplishments aimed at selling consumers on the facility, including the hiring of 30 physicians, Chest Pain Center Accreditation with PCI and Primary Stroke Center Certification.

As this announcement points up, an EMR launch is seen as a consumer marketing win, not just another project completion by the IT department. Of course, that’s the case partly because the launch comes with the release of a portal offering convenient data access and appointment scheduling. But I’d argue that EMRs have grown sexy enough in consumers’ minds that the mere use of one has some cachet by itself.

Now, this marketing strategy can backfire if the EMR launch goes poorly. For example, I’m sure the C-suite execs at Sutter Health were dismayed when the nurses’ union there went public with safety concerns about the Epic EMR implemented across the system.

For the most part, though, I think we’ll see hospitals bragging about their new EMR if it offers any advantage to consumers. EMRs have become a prominent enough part of medical care that implementing one wins the institution some brownie points.

Embattled Hospital Relies On Epic To Help Acquisition

Posted on October 28, 2013 I Written By

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

Here’s an interesting legal battle which puts a health system’s Epic EMR center stage.  Idaho-based St. Luke’s Health System, which is facing an antitrust challenge by a competing hospital, is responding to that challenge, in part, by citing the benefits of having an Epic system in place.

St. Luke’s was hit with an antitrust complaint lodged by Saint Alphonsus Medical Center, which claims that the system’s acquisition of Saltzer Medical Group of Nampa, Idaho will allow it to control nearly 80 percent of that market. The antitrust case, which involves both the FTC and the state of Idaho, is now before the U S District Court, reports EHR Intelligence.

During the proceedings last week, discussion focused on St. Luke’s decision to implement an Epic EMR, a move which reportedly cost $200 million. The install won’t be complete until 2017, according to the Idaho Statesman.

Though there’s a long road to walk before the Epic system will be complete, executives are already touting its benefits, with St. Luke’s CMIO testifying that Epic will allow patients to become engaged with their care, leading to better outcomes.

More importantly, for the purpose of the court  proceedings, adoption and implementation of the Epic system will eventually serve as the backbone of a St. Luke’s affiliate program under which independent doctors can use the system while paying only 15 percent of the costs, EHR Intelligence notes.

Saint Alphonsus Medical Center, for its part, argues that St. Luke’s reliance on the EMR is largely smoke and mirrors. In its joint pre-trial memorandum, the facility dismisses the claims regarding Epic’s benefits for Salzer as “speculative” and not a sufficient step to justify the acquisition. The memorandum also notes that Salzer already has its own EMR in place, making the purported benefits of substituting Epic even more tenuous.

So, what to make of this?  If nothing else, regardless of whether Epic contributes to the potential for this acquisition, the throwing down of the Epic gauntlet in court point to the prestige the vendor has achieved. Apparently, St. Luke’s feels that citing the availability of a system that won’t be fully implemented for five whole years is a workable defense given Epic’s high profile.

I find myself wondering whether a defense based on having another of the so-called “big 5″ EMRs would even be considered. Given Epic’s dominant position in the industry, it’s possible that it’s the only vendor whose name would do the trick.

Virtualization, Speech Recognition App Use Growing Among Hospitals

Posted on October 21, 2013 I Written By

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

Virtualization software and dictation with speech recognition are likely to see increased uptake among hospitals in coming years, according to data from HIMSS Analytics.

The data, which is drawn from its Essentials of the U.S. Hospital Market, Autumn 2013 report, suggests that virtualization and dictation with speech recognition are top areas for growth potential, ahead of most other apps profiled in the report.

According to a HIMSS statement, these findings are consistent with other research the organization has done in the past which has suggested growing adoption of voice recognition-based transcription technologies.

The HIMSS report also concludes that demand for ambulatory EMRs and ambulatory PACS seems to be growing, according to the press release.

My colleague John Lynn and I had a huddle to discuss these results and while I see the growth in demand for voice recognition, he’s a bit more skeptical.  In  his view, voice recognition hasn’t changed much over the last couple of years, so it’s not clear to him whey there’d be an upsurge in demand now. Did Siri-like technologies make us more comfortable with voice recognition?

The only exception to this, he suggested, may be some integration deals that Nuance did with Cerner and Epic that might cause an increase in voice recognition adoption. However, this will only be mostly those who wanted voice recognition already as opposed to converting new people to voice recognition.

On my end, I’m a bit more bullish on voice recognition technology, at least if EMRs are capable of parsing the narrative into fields in the EMR.  I’m aware of some EMR vendors and some independent software vendors that are doing this or headed in that direction.

As for virtualization, John is a bit more excited about the future. After all, as he notes, there’s some cost savings and redundancy, plus fail over, that are nice benefits of virtualization. He’s also a fan of its disaster recovery and business continuity capabilities, in that if one server dies, you can roll a whole virtual machine over to another seamlessly.

As for me, I’d argue that any technical trend you see here could be changed abruptly as the EMR market shifts. Let’s see how the next Meaningful Use phase, and the further consolidation of the EMR sector, affects what’s hot and what’s not.

Buy EHR vs Build EHR

Posted on October 14, 2013 I Written By

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

I’ve long had an interest in the topic of when hospitals chose to buy their EHR software versus build their EHR software. In fact, we’ve written multiple times on the subject including Anne Zieger’s piece on “Some Hospitals Still Choosing To Build Own EMR“.

With this as background, I was really intrigued by Dr. Edmund Billings’ blog post looking at how open source EHR is the best of both buy and build worlds. Here’s a good section of his article which frames the debate:

In a Buy vs. Build decision, the key drivers are control and cost. Do you have control over your system at a cost you can afford? The decision calculus then shifts to ownership on two levels: First, can we have true ownership of our solution and make it work ourselves? Second, is the total cost of ownership economically sustainable?

Dr. Billings then goes on to make the case that open source EHR is the best of both worlds. He compares the open source EHR vista to Linux and Red Hat to Medsphere. It’s a pretty app comparison of what Medsphere is trying to do. Dr. Billings does point out that an enterprise EHR is not an operating system (like RedHat/Linux). Although, I find that ironic since I’ve written before about how I think that the EHR is the operating system of healthcare.

One major difference between Linux and VistA is how they’re implemented. Linux could be implemented by an organization on just a server or two while still running all the old servers on something else. Then, over time they could add in more Linux servers. This isn’t the case with VistA. Everyone wants an Enterprise EHR to be implemented across the entire system. I don’t see someone implementing VistA in one department and then growing from there. Maybe we should do it this way, but that’s not what I see happening in the market. They buy an EHR system they can use across their whole organization.

This difference aside, open source does provide an interesting balance between the buy vs build mentality. I wonder why hospital organizations have chosen other EHR vendors over the open source EHR alternatives.

Should Hospital Associations Choose EMRs?

Posted on October 10, 2013 I Written By

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

Today I read a press release trumpeting the new relationship between the Texas Hospital Association and Enterasys Networks, which is now the THA’s preferred provider for wired and wireless network infrastructure products.

When I read this I found myself thinking “wow, is it really that easy?” Will hospitals rely on intermediaries like the THA to do the due diligence and sort out what sort of networking gear they should buy?

To me, this is an intriguing concept which could easily and logically extend to EMRs. After all, state hospital associations could do an analysis of an EMR’s technical strength, usability, interoperability and features as well as a  health system or hospital could.

It would certainly upend the industry if hospital associations routinely got down and dirty with EMRs, went through a selection process and put their “recommended” stamp on a small handful of systems.

If nothing else, it would be a shock to vendors, who would have to create new channel relationships with the associations, quickly and well. Marketing to associations wouldn’t superceded marketing to individual hospitals completely, but it would add a new layer of effort.

It would also give some attention to lesser-known EMR vendors. I’d argue that in an honest process, it’s unlikely that all — or even most — of the hospital associations would only choose as “winners” the enterprise EMRs that dominate the market today.  This is not to say that giants like Epic and Cerner would never be selected; it’s just that as I imagine it, a thorough hospital association selection process would identify some underdogs that deserve hospitals’ business.

The truth is, though, that most hospital associations wouldn’t want to go down the road of officially putting their stamp of approval on a small collection of EMRs. The task is enormous, the political costs high if members don’t agree with their choices, and the downside is considerable if a recommended vendor completely flames out in some way.

No,  it seems to me that while the THA has put its credibility on the line for Enterasys, I don’t see it (or its peers in other states) sticking an oar in the EMR selection business. There’s just too much at stake. They’ll spend their last penny fighting regulatory battles — particularly as Meaningful Use steams along — but hospital trade groups are not going to become the EMR Fairy.

Leveraging Vendor Neutral Archives Against EHR Vendor Lock In

Posted on October 3, 2013 I Written By

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

I recently heard of a new strategy that some organizations are employing to be able to avoid EHR vendor lock in. I’m happy to support anything that prevents EHR vendor lock in. The fact that a hospital can switch EHR software, doesn’t mean they will. However, the ability to switch EHR software usually means that the EHR vendor makes more effort to make sure they’re meeting the customer’s needs. This is why I think that preventing EHR lock in is so important. I don’t like EHR vendors resting on their laurels because a hospital has no choice but to use that software.

The method I heard described was a hospital who chose to implement a vendor neutral archive (VNA) of their EHR data. We usually hear VNA’s applied to radiology, but I predict over the next 3-5 years every large organization will have an EMR VNA as well. In this case, the hospital chose to implement a VNA while they were on good terms with their current EHR vendor.

Most EHR vendors won’t facilitate a VNA if you’re leaving them. So, it’s important that this is done before you choose to leave an EHR vendor. We also shouldn’t start assuming now that everyone that has a VNA is getting ready to part ways with their EHR vendor. In fact, I’d love for an EHR VNA to become the standard in the industry. That way, if and when an organization chooses to change software vendors, they can do so without losing all of the important data they’ve been collecting and storing in their EHR.

Just remember that it’s too late to employ this strategy when you’re ready to switch EHRs. It takes a forward thinking organization and investment to do this while everything is going great with your EHR vendor. Consider the investment insurance for a rainy day to come. I assure you that day will come for most healthcare organizations.

Cerner, Intermountain Form Major Development Partnership

Posted on October 1, 2013 I Written By

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

Normally, when I read the news of a vendor partnership, it’s a major snoozefest. After all, marketing deals and customer wins may be important to the vendor, but they don’t change our life much.

This time, though, I’m willing to go out a limb and say that the following is an important deal. Cerner, one of the leading players on the enterprise EMR front, has struck an agreement with healthcare chain Intermountain Healthcare under which the two will partner long-term on activity-based costing.

Intermountain, the largest health provider in the Intermountain West region of the US, is making a huge Cerner buy, Information Week reports. As part of its agreement with Cerner, Intermountain is tearing out its existing systems, including two EMRs, two billing systems and desktop integration system, and replacing them with Cerner technology.

In this deal, you can certainly chalk up one more win for Cerner, which has been gaining ground in the 200+ bed hospital segment of late. According to KLAS, the ratio of Epic-to-Cerner wins has fallen from 5-to-1 in 2010 to 2-to-1 in 2012 in this segment, according to the research firm.

But the agreement goes well beyond being a mere sale. Once the new, integrated Cerner system is in place, it will serve as the foundation for the long-term project partners have in mind.

Intermountain chose to partner with Cerner because of its system’s open architecture, which will allow for the addition of new content Intermountain plans to provide, CIO Marc Probst told Information Week.

The partners plan a closely-integrated relationship which involves the movement of several Cerner executives and staffers to Intermountain’s headquarters in Salt Lake City. Their work will include development of care process models, connectivity-based costing, advanced decision support and clinical workflows, IW reports.

Getting this work done requires little short of a wedding. ” “We’re looking at 20 plus years of collaboration. We have shared interests in making this be a great success,” Probst told the magazine.

EHRs Can Generate Meaningful Return On Investment

Posted on September 27, 2013 I Written By

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

Well-implemented EMRs can certainly generate Meaningful Use incentive payoffs, but that’s far from the only way that they can help a practice generate return on their EHR investment.

According to “Return on Investment in EHRs,” a whitepaper sponsored by GBS, HP, Intel and Nextgen, properly implemented EHRs can do a great deal to generate ROI for medical practice above and beyond qualifying them for MU payoffs.

The paper notes that many practices have achieved a return on investment in their EHRs without receiving external incentives. As it points out, a Health Affairs study from 2005 found that while initial EHR costs averaged $44,000 per full-time equivalent, and ongoing costs averaged $8,500 per provider per year, the average practice paid for EHR costs in 2.5 years and generated a profit after that.

Eleven of the 14 practices studied by Health Affairs had “tightly integrated” EHR and practice management systems, a factor the paper contends was highly relevant to their success with their EHR implementation. Not only did providers use the EHR for common tasks, almost all used it to help with billing. Ten of the practices no longer pull paper charts at all, the study noted.

EHRs also improve efficiency and productivity in the following ways, the paper argues:

* More appropriate coding: Properly-designed EHRs help physicians with coding by displaying the appropriate code based on the documentation entered during a patient encounter. This avoids costly undercoding.

* Greater efficiency: The use of point-and-click templates lessens and in some cases eliminates transcription costs, which can be up to 11 percent of collections.

* Reduction in soft costs: Fully-enabled EHRs also remove many “soft costs” that practices occur, such as the time it takes to call in prescriptions. Also, once doctors learn how to use the EHR, they can complete most of the notes during or between patient visits, leaving them with time to either see more patients or go home earlier.

It’s great to think that medical practices can generate ROI on their EHR investment, but given that the sponsors of this paper have their own agenda, I’m not taking everything they say at face value. What do you think, readers? Have you seen situations in which practice EHRs generate significant ROI independently of what they take in in Meaningful Use dollars?