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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?

Stanford Uses Epic Feature To Conduct Web Visits

Posted on September 20, 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.

Stanford Hospital & Clinics has rolled out a new primary care service, powered by a feature available within its Epic EMR, offering medical visits via web video.

The new service allows patients to schedule video visits via the hospital website, using a scheduling application available on the site, InformationWeek reports. At the scheduled time, patient and doctor meet together in a web-based video conference.

The service, which Stanford dubs “eCare,” takes advantage of Epic’s software for video consultations. The video consult is integrated into the patient’s Epic medical record automatically. eCare also integrates third–party identity verification services in an effort to make sure the patient is who they say they are.

According to Stanford CIO Pravene Nath, M.D., who spoke with InformationWeek, video visits are medically appropriate for a range of noncritical visits and follow-ups. For example, one of the service’s first patients had an eye condition; the doctor was able to help simply by looking into the camera at the patient’s eyes. Another example of condition appropriate for web conferencing is treatment of a skin rash, Nath said.

“These are cases where a quick visual is all that is needed, followed by a quick interaction of the patient talking with the doctor,” Nath told InformationWeek.

Stanford is offering eCare first to employees of self insured firms who contract with the hospital. That way, neither the employer nor Stanford has to worry about whether a managed-care company will reimburse the doctors for the video visits. But Stanford’s intent is to make video consults available to everyone, InformationWeek says.

Stanford’s care program is just one of several virtual healthcare services the hospital’s developing, IW reports. The organization is also looking into secure messaging between doctors and patients and a service which involves submitting a still photo of them conducting a live videoconference, the magazine says.

If Stanford can make the integrated EMR and web visits work, it may be breaking new ground. A few months ago, I wrote a piece noting that many telemedicine providers are very reluctant to integrate with EMRs, given that the need for interoperability with so many systems could choke their development efforts.

While enabling telemedicine isn’t going to offer Epic any huge advantage it doesn’t have already, it does offer some intriguing possibilities. If thought leaders like Stanford make a success of web visits, using Epic technology, it might force other competitors into the telemedicine arena as well. It will be interesting to see how influential Stanford’s experiment turns out to be.

Judy Faulkner Interoperability Chart

Posted on September 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Farzad Mostashari shared the following tweet which includes a picture of the growth in standards-based exchange per Judy Faulkner.

Here’s a blown up version of the chart (click on the image for an even larger version):
Epic Data Sharing Chart

As Farzad notes in the tweet, the patient records exchanged per month is now up to 1.25 million. It’s also worth noting that the red bar in the chart is exchange of records from Epic to Epic. The Green bar in the charts is from Epic to Non-Epic. I hope that green bar continues to grow since as the chart displays, that’s a definite shift in strategy for Epic. Let’s hope this shift continues until the data in healthcare is available where it’s needed when it’s needed.

Ohio HIE Hits 101-Hospital Mark

Posted on September 12, 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.

This is a very busy time for HIE builders.  In recent months several states have either announced that they’d completed their preparations for a broad-based HIE or reached a new milestone in HIE participation.

For example, earlier this month the state of Wisconsin announced that it is gearing up to kick off a statewide HIE network that would embrace hospitals, clinics, nursing homes and other care facilities, powered by HIE technology vendor Medicity.

According to Health Affairs, this is part of a larger trend. A recent piece in the journal noted that health data exchanges between hospitals and other healthcare providers have climbed 41 percent between 2008 and 2012.

The latest in state HIE news comes from Ohio, where the state’s HIE has just announced that it had signed two hospitals, 25 bed Harrison Community Hospital in Cadiz as well as 91-bed Wilson Memorial Hospital in Sidney, reports Healthcare IT News.  With the new additions, Ohio’s CliniSync HIE now boasts 101 of the state’s hospitals.

CliniSync, which is run by the nonprofit Ohio Health Information Partnership, is based on Medicity technology as well.  With these new members, and the momentum it has underway, CliniSync might well be one of the largest public HIEs in the U.S. by 2014, Healthcare IT News reports.

According to Healthcare IT News, CliniSync makes it possible for physicians, hospitals, nurses and others who do patient care to share patient data electronically. What’s really neat, if true, is that CliniSync will allow doctors and hospitals with varied EMRs to share data. Previously, the HIE members could only share data regionally or within their own systems.

Epic Rollout Contributes To $55M Loss At NC Hospital

Posted on September 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.

It’s no secret that rolling out an Epic EMR is a big-ticket investment. What’s also becoming apparent is that some of the hospitals that take the plunge can’t really afford to pay for what they’ve bought, much less staff and develop an Epic presence.

The latest Epic EMR financial casualty to cross my desk is Wake Forest Baptist Medical Center which, according to the Winston-Salem Journal, saw a $55.1 million operational loss partly due its Epic rollout during fiscal 2012-13.

In a regulatory filing directed to bond investors, Wake Forest Baptist said that the Epic implementation had a substantial negative impact on fiscal 2013 due to both direct implementation costs and associated indirect expenses, according to the Winston-Salem Journal.

While the hospital’s stock investment gains of about $54 million helped offset most of the operational loss, leaving the overall loss at a much smaller $571,000, this fiscal year’s performance is still much worse than the previous year, when Wake Forest had $45.8 million in operational revenue and overall excess revenue of $88.7 million, the newspaper reports.

But the direct expenses and development costs weren’t the real capper, the newspaper said. The biggest Epic-related blow to Wake Forest Baptist came from $53.7 million in indirect impact, including $36.9 million of lost margin due to volume disruptions during the initial go-live and post go-live optimization. On top of that, the hospital reported $16.8 million in other Epic-related implementation expenses.

And that led to a shakeup in the C-suite. Giving the lie to the notion that nobody ever got in trouble for buying Epic, earlier this year, the hospital’s chief information officer of Wake Forest Baptist resigned in the middle of the troubled Epic launch.

In the article, the newspaper reports that Wake Forest Baptist “remains confident in Epic’s long-term benefit to the center”, and that hospital CEO Dr. John McConnell believes that the install “was absolutely necessary for patient safety,” he told the Winston-Salem Journal .

While it may turn out to be true that Wake Forest Baptist will be able to improve patient safety using its Epic EMR, in the mean time it’s having cut back on staff to pay for that gain. According to the newspaper, the center had planned to eliminate at least 950 jobs during the recent fiscal year;  some were not eliminated but may be during this fiscal year.

KLAS: Epic Losing Ground To Cerner

Posted on September 6, 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.

At this point in the EMR buying cycle, one would figure that the market for new hospital EMR purchases is pretty saturated, especially among larger hospitals with the capital to invest in big health IT projects. But according to a recent blog entry from KLAS, that’s not exactly the case.

In his blog item, KLAS researcher Colin Buckley notes that his firm has been watching clinical IT vendor wins and losses at 200+ bed hospitals for 10 years.  During that period — and especially post- Meaningful Use — KLAS has seen a growing number of new hospital EMR contracts.

By this point, after lots of EMR buying, and some switching out technology for second and third-choice EMRs, one might think that over-200-bed hospitals had settled on a platform that they could live with through Meaningful  Use Stage 3. Actually, not quite, Buckley says.

In fact, KLAS data shows that there are more hospitals running legacy EMRs, homegrown EMRs or no EMR at all than those who have bought a currently-marketed solution sometime in the past four years. And it’s likely these hospitals will be choosing a new EMR from the current vendor marketplace within the new few years, KLAS projects.

As sales increase in the 200+ bed hospital segment, market forces are shifting to favor new vendors. What’s particularly noteworthy about this is that the research firm has seen the ratio of Epic-to-Cerner wins shrink from 5-to-1 in 2010 to 2-to-1 in 2012.

According to KLAS, the hospitals that are likely to be out buying new EMRs look different than those which have already bought and implemented the EMR they’ll use for the next several years. “They are smaller and more cost conscious than the large hospital IDNs that have given Epic a lion’s share of wins year after year,” Buckley writes.

With Cerner and Epic busy eating each other’s lunch, Allscripts, MEDITECH, McKesson and Siemens are moving ahead as quickly as possible to roll out integrated ancillary and ambulatory solutions, Buckley notes. In other words, the competition for both ambulatory and hospital EMRs is far from played out.

Despite all of this activity, we are clearly in a late stage of the EMR market as a whole, or as my colleague John Lynn puts it, “the Golden Age of EHR adoption is over.” But if KLAS is right, there’s still some very healthy bucks to be made selling to laggard mid-sized hospitals. Let’s see if vendors used to serving hospital giants can adapt in time.

Will Hospitals Be Penalized If Their EHR Vendor Isn’t 2014 EHR Certified?

Posted on August 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Let me state the obvious. An EHR implementation in a hospital is a time consuming and expensive effort. While the idea of switching EMR software is a palpable discussion in the ambulatory space, it is a much more difficult discussion in the hospital EMR space. I heard one hospital CIO whose hospital decided to switch EHR software say it took them 2 years to make this decision. The idea of switching EMR software is not even a discussion point for many hospital CIOs.

With this in mind, I was intrigued by today’s #HITsm chat where we talked about meaningful use stage 2. More than a few people suggested that many EHR vendors are going to fail to meet the meaningful use stage 2 requirements and be 2014 EHR certified. I’ve personally suggested that I don’t think this will be the case. EHR vendors have far too much to lose to not be certified. However, more than a few people disagree with me on this subject, so I started to consider what this would mean for an organization.

For those of you who also read EMR and HIPAA, you might remember my post earlier this year called EHR Penalties after Meaningful Use Failure. In it I discuss how damaging it would be for a hospital that makes a sincere commitment to EHR and meaningful use to then fails to get the EHR incentive money because they fall short of meaningful use or fail an MU audit.

A similar situation could occur if a hospital’s EHR vendor isn’t able to meet the meaningful use stage 2 EHR certification requirements. What does the hospital do in this case? Will they miss out on the EHR incentive money and also suffer the EHR penalties because their EHR vendor wasn’t ready for meaningful use stage 2?

Like I said, I’ll still be surprised (especially in the hospital EHR space) if all the hospital EHR vendors don’t become 2014 EHR certified. However, if they don’t, a lot of hospitals will be put in a precarious position.

My guess is that if this happens, ONC will make an exception in the penalties for not being a meaningful user. I can’t imagine them penalizing a hospital who’s trying to be a meaningful user of an EHR and can’t because of their EHR vendor’s inability to perform. Although this would start a slippery slope of exceptions.

Either way, I want to dig into this topic more. How many EHR vendors won’t have their EHR certified for meaningful use stage 2? What are the timelines for them to complete this certification and then for hospitals to implement everything for MU stage 2?

KLAS Reports Cerner and Epic Combined to Capture More Than 3/4 of New Large Hospital EMR Contracts

Posted on August 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

This tweet and associated messages are circling all around social media. Here’s the short description of the KLAS report:

HITECH has drastically changed the acute care EMR market. Previous industry mainstays like GE Healthcare and QuadraMed have effectively dropped out. McKesson has promoted their community hospital solution, Paragon, over their former flagship, Horizon. Allscripts, MEDITECH, and Siemens are all racing to recover from past stumbles and regain market share. Since meaningful use became a reality, Cerner and Epic have captured a large majority of new hospital contracts. However, there are still many decisions to be made in coming years and the remaining market is potentially more competitive than in years past.

For those of us following the industry, this isn’t really big news. Cerner and Epic have been battling for the big hospitals for quite a while. In fact, coming out of this year’s HIMSS I was more interested in the battle for small hospitals than large hospitals. Of course, we’ll see how hospital consolidation affects this as well.

What does seem clear and this report confirms is that Epic and Cerner all well positioned in the large hospital EMR market. I predict they’ll dominate until at least the end of meaningful use.

Feds Plan EMR Certification For Specialty Facilities

Posted on August 13, 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.

Federal HIT leaders are planning to set up a voluntary program for testing and certification of EMRs used by behavioral health, long-term care and post-acute care, according to a story in Modern Healthcare. 

As things currently stand, they’re off the hook, as ARRA doesn’t require long-term or behavioral health facilities to buy certified EMRs.

These plans came to light last week at a webinar held by outgoing ONC head Farzad Mostashari, who said that his office is working on what the scope of such a program should be, MH reports. The webinar was held to discuss government officials’ reaction to public comments on how to improve interoperability.

In its original request for input, federal regulators noted that 4 in 10 hospitals were sending lab and radiology information to outside providers, though only one in four were  exchanging medication lists and clinical summaries, Modern Healthcare said.

Meanwhile, only 6 percent of long-term acute-care hospitals, 4 percent of rehab hospitals and 2 percent of psychiatric hospitals had even a basic EMR, the feds reported.

Launching these specialty-focused options seems like a logical next step for the certification program, and a long-delayed one at that. EMR certification has been a fact of life for several years, since then-ONC chief David Brailer kicked off the formation of the CCHIT.

Over the long haul, however, such new certification options may not be worth much unless they’re better matched to provider needs. My colleague John, for one, thinks the certification will have to change to actually offer value to doctors and healthcare organizations.

What do you think, readers?  Do you think certification programs for EMRs are a waste of time, or do you see them doing anything meaningful to improve care?