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Another Epic Loss: Iasis Upgrades To Cerner

Posted on January 20, 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.

It’s too early to make a definitive claim, but I’m picking up some increasing evidence that Cerner is beginning to win out over Epic as some health systems upgrade. I’m not suggesting that Epic is ready to topple by any means, but it does seem that Cerner’s winning more potential matchups than they were before.

Want an example? Take the recent news that Iasis Healthcare will switch out its McKesson platform for the Cerner  Millenium EMR.  The 17-hospital system will spend $50 million to make the upgrade, which should be complete by March 2018. Most of the spending is ($35M+) is projected to come in fiscal 2016.

As I noted in an earlier post, Epic continues to grow at, well, an Epic pace. Reports suggest that Epic added 1,400 staffers last year, and the company seems likely to keep on pace in 2016. And as I previously noted, Epic software is either being used by or installed at 360 healthcare organizations in 10 countries, and also reported generating $1.8 billion in revenues for 2014.

But as the Iasis deal illustrates, Cerner is picking up some split-decision deals for what look like important reasons. One intriguing reddit post by captainnoob explains why his health system went with Cerner:

We whittled our choice down to 3 applications… McKesson Paragon, Epic, and Cerner. Those 3 were our forerunners as they were fully integrated and had modules to handle (almost) every service our facility provides. Ultimately the decision to go Cerner was based primarily on a combination of user input and cost of ownership.

  • User Input – We did numerous site visits with users from various clinical and managerial areas to talk workflow, ask questions such as how each product dealt with certain challenges we have already faced with McKesson, and view demonstrations in real-world conditions.
  • Cost of Ownership – Not just the cost of the product and implementation, but the cost of maintaining the product over 5-10 years.

I’m not sure why the competitive advantages Cerner has have shown up in higher relief recently. But my guess is that the wins Cerner is capturing have something to do with the psychology of EMR investment.

Going from a severely underpowered system — or none — to Epic involves taking a big leap of faith. How can you rationalize spending dozens or even hundreds of millions (or billions) on Epic? I’d argue that in essence, the ROI on that buy has been essentially unguessable. So the systems that have made a big Epic buy have had to justify their investment by pointing to big, still-intangible benefits like improved population health.

On the other hand, health systems that didn’t do Epic the first time, and have reasonably competent systems on board already, aren’t buying vision or reputation-ware. They aren’t pioneers, but instead, are looking for an economically and technically workable solution. In that circumstance, I know I’d be far more likely to go with a system with a lower total cost of ownership than an expensive Big Blue-style tool.

But these are just my theories. What do you think?  Is the investment tide turning toward Cerner, and why?

Epic EMR Costs Drag Down Finances At Brigham and Women’s

Posted on January 4, 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.

It’s worth noting from the outset that many healthcare organizations have had it worse. Epic installs have blown health system budgets sky high, sapped their profitability and undermined their credit ratings. So upon hearing the following you may not be tempted to play a sad song on the world’s smallest violin.

Still, it’s worth noting that in part due to the costs of its Epic implementation, the venerable Brigham and Women’s Hospital will fall $53 million short of its expected $121 million surplus for fiscal 2015. According to news reports, this is the first time Brigham and Women’s has missed such a target in more than 10 years.

The hospital’s president, Betsy Nabel, MD, noted that the Brigham and Women’s install is part of a massive $1.2 billion Epic implementation cutting across the 10 hospitals of the Partners HealthCare system. The broader Partners implementation is proving to be a budget-buster as well. Three years ago, Partners went into the effort with a comparatively scant $600 million budget.

Brigham and Women’s — along with nearby Dana-Farber Cancer Institute — hired 1,500 extra staff members to help with the Epic go-live, which took place in June of this year. The Brigham had budgeted $47 million during the previous year to pay for the transition costs.

But the transition cost $27 million more than expected. For one thing, once they began using the EMR, Brigham and Women’s staff apparently undercoded a bunch of visits, lowering patient care revenues.  The hospital also gave up some revenue voluntarily, by cutting back on patient volume during the first months post-go-live to ease the transition.

The rest of the shortfall came from lost patient volume in February due to heavy snowfall, as well as paying more than it had expected into its employee pension fund.

A few words of commentary seem called-for here.

* It’s not clear to me why the staffers made so many coding mistakes going out the door with the new install. I’ve written about perhaps a dozen Epic installs in depth, and have studied many more, and a rash of post-implementation coding mistakes doesn’t seem to be common. Am I missing something, or were the staffers undertrained?

* News reports suggest that nearly $14 million of the unexpected costs came from the planned reductions in patient care volume. It seems to me that if Brigham and Women’s execs planned for that shortfall, they’d know how much it was going to be. Why all of the surprise already?

By the way, the shortfall apparently kicked up so much dust that Dame Judy personally flew out to Boston to meet with the hospital leadership to head off PR trouble offer guidance.

Following the meeting, hospital president Dr. Betsy Nabel told a town hall-style gathering that all is well — that the coding problems will pass and revenue levels reestablish themselves. And after all, she noted, the Epic install is already working well enough that there’s been no increase in medical errors at the hospital.

Well, that’s a start at least. Keeping medical errors from getting worse is certainly a good thing. But for its sake, let’s hope the Brigham expects more than that from Epic!

Rural Hospitals Catching Up In HIT Adoption

Posted on December 14, 2015 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.

Historically, rural hospitals have lagged when it comes to health IT adoption. But according to at least one yardstick, the HIMSS EMR Adoption Model (EMRAM), rural facilities seem to have closed much of the gap.

Just a few years ago, many rural hospitals were barely at stage one of the model, which ranks facilities from Stage 0 (All three ancillaries not installed) to Stage 7 (Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP). Only two years ago, research suggested that rural and critical access hospitals were lagging far behind in meeting Meaningful Use criteria, and risked incurring penalties this year.

By the end of 2014, however, rural hospitals averaged a Stage 4 rating (CPOE, Clinical Decision Support (clinical protocols). This compares favorably with the 4.7 rank achieved by urban hospitals, and though academic/teaching hospitals were well ahead at a 5.4 ranking, that’s a much smaller difference than you might have seen even five years ago. Meaningful Use incentives, plus overall industry pressure to automate, seem to have done their job.

I’m pondering this, in part, because the CPSI acquisition of Healthland piqued my interest. CPSI picked up Healthland, a provider of rural and critical access hospital software, for $250 million. Given rural hospitals’ history of slow HIT adoption, I wasn’t sure what CPSI saw in Healthland, though the deal does bring revenue cycle management and an EMR for post-acute care facilities to the table.

Now that I’ve learned what progress the rural health IT market has seen, I’m no longer so skeptical. In fact, when you consider that the Healthland acquisition brings 3,300 post-acute customers that it didn’t have before, it seems like CPSI got a pretty nice deal.

Given the growing strength of the rural HIT market, I don’t think the Healthland buyout will be the last domino to fall here. I can easily imagine the giants — Cerner in particular — seeing their way clear to acquiring the combined CPSI/Healthland entity. Why Cerner? Well, if for no other reasons than having a ton of cash — and a more flexible attitude than Epic — I can imagine Cerner getting excited about rural access.

But even putting aside M&A dynamics, the news from rural markets is still intriguing. While having sophisticated health IT infrastructure is a plus anywhere, my guess is that it will be particularly powerful for rural and critical access hospitals. I hope that the growth of HIT capabilities brings a breath of fresh air — and the benefits of cutting-edge care management — to facilities that have traditionally gotten the short end of the stick.

Meditech EHR Market Share

Posted on November 25, 2015 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 got subscribed to the Navin, Haffty & Associates email newsletter. The title on their website claims they’re the “Largest and Most Respected MEDITECH consulting firm.” I’ll let you decide on those two counts, but they’re clearly all in as a consulting firm with MEDITECH. In their latest newsletter John Haffty, President of Navin, Haffty & Associates, shared some statistics on MEDITECH market share that I thought might be of interest to readers:

Statistically speaking, MEDITECH has over 2,400 clients. The number of MEDITECH clients by platform is outlined below:
Client/Server – 1,056
MAGIC – 848
6.x – 546

Over the past five years 285 clients have been added, 137 of which implemented 6.x. Clients often add their existing platform as they acquire hospitals and this has resulted in the addition of 22 MAGIC and 126 Client/Server sites. In addition, MEDITECH has signed 31 organizations for the new Ambulatory product. Of the 546 Ambulatory 6.x sites, 279 have chosen 6.1, with some already LIVE.

MEDITECH’s market share for hospitals by bed size demonstrates a strong industry presence:

23% – under 99 beds
36% – 100-199 beds
36% – 200-299 beds
27% – 300-399 beds
17% – 400+ beds

I’ve long argued that MEDITECH was still a sleeping giant in the EHR space. Epic and Cerner gets most of the headlines, but MEDITECH still has a massive market share. Of course, after CPSI’s acquisition of Healthland today, it looks like CPSI wants to play as well.

5 Pieces of Advice When Checking Out Epic or Cerner

Posted on September 29, 2015 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.

Elise Ames and Vince Ciotti has an interesting follow up post on Health System CIO that looks at Epic versus Cerner in the hospital EHR (or HIS if you prefer) market. The reality is pretty simple. Epic or Cerner are both going to be around for a long time to come. Although, I really enjoyed the 5 pieces of advice they offer at the end of the post for those buying a new car EHR (LIS):

  1. Owner’s manual —it’s sitting right there in the glove box. For an HIS, check out the user manuals – they’re all on-line today. And unlike RFP feature checklist responses, they contain the truth…
  2. Chat with the mechanics — they know what works well, and what breaks the most. For an HIS, ask to meet your implementation project manager before signing, and ask about their staff and (non?) experience…
  3. Take a test drive in the model you’re buying, and on the roads you’ll be travelling. For an HIS, make unchaperoned site visits and phone calls to client hospitals of your size and using your apps…
  4. Check out the warranty — what’s covered versus what’s not? With an HIS, ask for a boilerplate contract and request changes while you still have some competitive pressure…
  5. Negotiate price — don’t tell the Chevy dealer he won, then ask for a discount. Tell him you may buy a Ford unless he gives you a deal… After all, no one pays list price for a mega-buck HIS, do they?

I’ve heard of many of these suggestions before. However, the first one was one I hadn’t heard before. It’s a great idea and is the beauty of the internet. I’m also surprised by those that don’t do “unchaperoned” visits to current users of an EHR. Yes, it’s one thing to go to a reference site for an EHR. That’s a good thing as well, but you’ll get more value visiting one that isn’t a reference site per se.

Learning About Interoperability from Other Industries

Posted on September 21, 2015 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.

In my recent post about DeSavlso suggesting we needed a common interoperability standard, Karl Walter Keirstead offered the following comment:

Finally, someone in government agrees that MU has not had a focus on the right things.

It’s amazing to me, coming from the industrial process control domain where interconnectivity across multiple systems and applications has been routine for 70 years, to see healthcare fussing over interconnectivity.

Their is no need to standardize.

Each set of trading partners the publisher needs to format data for easy posting to a generic data exchanger and the subscriber needs to be able to read data at the data exchanger for easy import to the subscriber environment.

The design criteria are that each partner be allowed to read/write using their own native data element naming conventions (i.e. I post “abc”, you want to be able to read it as “def”, a 2nd subsriber may want to read “abc” as “ghi”.

Of course, a long name is required per publisher data element so that subscribers are able to figure out what they are subscribing to and the other requirement is that a publisher be able to share on a need-to-know basis.

And, yes, since the usual setup will be “pull” instead of “push” each subscriber needs to be able to retain a cursor position at the exchange so they know the last line item they read.

I always learning from other industries and I think the way Karl frames it is really valuable. There are a few challenges that are unique to healthcare. First, we’re talking about 300 different EHR vendors. I guess you could argue that there are even more suppliers in industry for say something like a car or a computer, so they understand integrating with a lot of vendors. However, I think it’s slightly different since all 300 EHR vendors are trying to do more or less the same thing. Still doable, but it does add some different dynamics.

Second, I think that healthcare data is an order of magnitude more complex than much of the data that’s being shared in other industries. I still feel like that’s an excuse as opposed to a real reason for it not to happen. I know this because for years we’ve seen this data being shared at the HIMSS interoperability showcase. It’s more about will than it is about the complexity.

This all reminds me of the time I asked Judy Faulkner, CEO of Epic, if she knew the opportunity she was sitting on. She gave me a blank stare and asked what I meant. I then proceeded to tell her that if she opened up Epic to other people she’d effectively create a standard that everyone would adopt. That’s essentially what I think Karl is saying when he says:

Each set of trading partners the publisher needs to format data for easy posting to a generic data exchanger and the subscriber needs to be able to read data at the data exchanger for easy import to the subscriber environment.

Yep. Epic, Meditech, and Cerner could create a standard for EHR interoperability and everyone would start to use it. Good standard. Bad Standard. It wouldn’t matter, their “trading partners” would adapt to whatever they set as the standard.

Antitrust In The Brave New EMR World

Posted on September 18, 2015 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.

Late last month, former Brigham and Women’s Hospital CEO Paul Levy made waves in the health IT world when he accused Epic of conspiring with Boston healthcare system Partners HealthCare.

In a post on his wryly-named Not Running a Hospital blog, Levy argues that Epic’s relationship with Partners raises antitrust concerns:

Here’s how it works.  Partners enters into a contract with Epic for the construction of an EHR for its facilities.  The two organizations go to the Partners-affiliated, but independent, medical practice groups and tell them that they have to install the Epic EHR–even if the EHR they have had for years is perfectly adequate for their purposes.  If a doctor’s practice asks why they can’t keep their old system, Epic makes clear that interoperability between its system and the practice’s legacy system is not feasible.  Meanwhile, to clinch the conversion, Partners also informs the local practices that failure to install the Epic system will foreclose those practices from participating in the favorable insurance contracting relationships it enjoys.  It is in this manner that the Epic-Partners actions box out the competition in this market.

In his article, Levy calls on Massachusetts Attorney General Maura Healey, and attorneys general of other states for that matter, to be on the lookout for similar deals between Epic and health systems elsewhere.

Interestingly, in other cases health systems accused of seeking excessive market power have used their Epic investment as a defense. For example, when its 2012 acquisition of Nampa, ID-based Saltzer Medical Group was challenged by the FTC, Boise health system St. Luke’s cited its $200M Epic system as a mitigating factor. Its lawyers asserted that St. Luke’s investment in effort was proof that the health system would be able to improve the region’s healthcare by better care coordination.

But the argument didn’t fly with the FTC, which didn’t believe that tying employed doctors to an EMR was needed to generate regional healthcare efficiencies. “Shared access to electronic medical records that St. Luke’s cited as a central benefit of the transaction can be achieved without an employment relationship or merger,” said Deborah Feinstein, director of the FTC’s Bureau of Competition at a speech given last year.

In my opinion, both Levy and Feinstein make excellent points. If Levy is right, it can easily be argued that Partners and Epic are engaging in questionable behavior, as it troubles at least this non-lawyer to see doctors strongarmed into using any particular EMR. And given that St. Luke’s was in the process of building a program to coordinate with unaffiliated physicians, it does seem that crying “we have Epic!” doesn’t address the problem.

But these are just bullet points. Overall, my sense is that neither state attorneys general nor the FTC and DoJ are sure how EMRs impact a health system’s market power, nor what constitutes anticompetitive behavior on the part of a vendor. I don’t know whether regulators don’t see EMR issues as a priority or are simply biding their time, but from my standpoint they are more than ripe for attack. What do you think?

Another Giant In Play: 3M Looking At “Strategic Alternatives” For HIS Unit

Posted on September 14, 2015 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.

Given the staggering number of EMR launches that took place in the wake of the Meaningful Use kickoff, mergers, sell-offs and business failures were quite predictable. Despite the feds’ doling out $30B in incentive dollars, even that wasn’t enough to keep hundreds of EMR entrants afloat.

It hasn’t been as clear what would happen to large vendors with HIT interests, given that they had enough capital to ride more than one wave of provider adoption. The field has just begun to shake out, with only a small handful of major transactions taking place. Recent plays by large tech players include Cerner’s $1.3B acquisition of Siemens Health Services, which included the Soarian EMR. There’s also ADP’s sale of EMR solution AdvancedMD to Marlin Equity Partners after previously acquiring e-MDs. Not to mention Greenway and Vitera Healthcare Solutions joining forces and Pri-Med acquiring Amazing Charts.

Another major move was announced this April at HIMSS 15, when GE Healthcare announced that it was phasing out its Centricity Enterprise product. According to news reports, the Enterprise product only generated 5% of the Healthcare division’s EMR revenue. I could keep going, but you get the point.

Now, 3M has joined the fray, announcing this week that it was “exploring strategic alternatives” for its HIS business, including spinning off or selling the unit.  (It’s also considering keeping its HIS business on board and investing in its future.)  The company, which has signed Goldman, Sachs & Co. as strategic advisor and investment banker, says that it will probably announce what direction it will head in by the end of the first quarter of next year.

On the surface, 3M Health Information Systems looks like a very solid business. The HIS unit, which is focused on computer-assisted coding, clinical documentation improvement, performance monitoring, quality outcomes reporting and terminology management, reportedly works with more than 5,000 hospitals, plus government and commercial payers. According to 3M, the HIS business generated trailing 12-month revenues of about $730M, and has sustained 10%+ compounded annual growth for 10 years.

That being said, it’s hard to say what the fallout from the ICD-10 switchover will be, and it’s not unreasonable for 3M to consider whether it wants to compete in the post-switchover world. After all, while the HIS unit seems to be quite healthy, it’s certainly faces stiff competition from several directions, including EMRs with integrated billing and coding technology. Also, the company may be saddled with outdated legacy infrastructure, which makes it hard to keep up in this new era of revenue cycle management.

By the end of the first quarter of 2016, 3M will have had a chance to see how its customers are faring post-ICD-10, and how its customers needs are shifting. 3M will also find out whether other HIS players with (presumably) newer technology in place are interested in doing a rollup with its business.

Truthfully, if 3M doesn’t think it can benefit from investing in the HIS unit, I’m not sure who else would benefit from doing so. In fact, I’d argue that 3M is undermining its chances at a deal by waffling over whether it plans to invest or divest; as I see it, this implies that the HIS unit will be on life support without a major cash infusion, which is not something I’d find attractive as an investor.  If nothing else I’d want to buy the unit at a firesale price! But I guess we’ll have to wait until March 2016 to see what happens.

EMR Vendors Slow To Integrate Telemedicine Options

Posted on August 27, 2015 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.

Despite the massive growth in demand for virtual medical services, major EMR vendors are still proving slow to support such options, seemingly ceding the market to more agile telemedicine startups.

Independent telemedicine vendors targeting consumers are growing like weeds. Players like Doctor on Demand, NowClinic, American Well and HealthTap are becoming household names, touted not only in healthcare blogs but on morning TV talk shows. These services, which typically hire physicians as consultants, offer little continuity of care but provide a level of easy access unheard of in other settings.

Part of what’s fueling this growth is that health insurers are finally starting to pay for virtual medical visits. For example, Medicare and nearly every state Medicaid plan also cover at least some telemedicine services. Meanwhile, 29 states require that private payers cover telehealth the same as in-person services.

Hospitals and health systems are also getting on board the telemedicine train. For example, Stanford Healthcare recently rolled out a mobile health app, connected to Apple HealthKit and its Epic EMR, which allows patients to participate in virtual medical appointments through its ClickWell Care clinic. Given how popular virtual doctor visits have become, I’m betting that most next-gen apps created by large providers will offer this option.

EMR vendors, for their part, are adding telemedicine support to their platforms, but they’re not doing much to publicize it. Take Epic, whose EpicCare Ambulatory EMR can be hooked up to a telemedicine module. The EpicCare page on its site mentions that telemedicine functionality is available, but certainly does little to convince buyers to select it. In fact, Epic has offered such options for years, but I never knew that, and lately I spend more time tracking telemedicine than I do any other HIT trend.

As I noted in my latest broadcast on Periscope (follow @ziegerhealth), EMR vendors are arguably the best-positioned tech vendors to offer telemedicine services. After all, EMRs are already integrated into a hospital or clinic’s infrastructure and workflow. And this would make storage and clinical classification of the consults easier, making the content of the videos more valuable. (Admittedly, developing a classification scheme — much less standards — probably isn’t trivial, but that’s a subject for another article.)

What’s more, rather than relying on the rudimentary information supplied by patient self-reports, clinicians could rely on full-bodied medical data stored in that EMR. I could even see next-gen video visit technology which exposes medical data to patients and allows patients to discuss it live with doctors.

But that’s not how things are evolving. Instead, it seems that providers are largely outsourcing telemedicine services, a respectable but far less robust way to get things done. I don’t know if this will end up being the default way they deliver virtual visits, but unless EMR vendors step up, they’ll certainly have to work harder to get a toehold in this market.

I don’t know why so few EMR companies are rolling out their own virtual visit options. To me, it seems like a no-brainer, particularly for smaller ambulatory vendors which still need to differentiate themselves. But if I were an investor in a lagging EMR venture, you can bet your bottom dollar I’d want to know the answer.

EMRs Must Support Hospital Outcomes Reporting

Posted on August 25, 2015 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.

Should a hospital be paid if it doesn’t make its outcomes statistics public? Pediatric heart surgeon Dr. Jeffrey Jacobs says “no.” Jacobs, who chairs the Society of Thoracic Surgeons National Database workforce, recently told CNN that he believes reimbursement should be tied to whether a hospital shares data transparently. “We believe in the right of patients and families to know these outcomes,” said Jacobs, who is with the Johns Hopkins All Children’s Heart Institute in St. Petersburg, FL.

Jacobs’ views might be on the extreme side of the industry spectrum, but they’re growing more common. In today’s healthcare industry, which pushes patients to be smart shoppers, hospitals are coming under increasing pressure to share some form of outcomes data with the public.

I’ve argued elsewhere that in most cases, most hospital report cards and ratings are unlikely to help your average consumer, as they don’t offer much context how the data was compiled and why those criteria mattered. But this problem should be righting itself. Given that most hospitals have spent millions on EMR technology, you’d think that they’d finally be ready to produce say, risk-adjusted mortality, error rates and readmissions data patients can actually use.

Today, EMRs are focused on collecting and managing clinical data, not providing context on that data, but this can be changed. Hospitals can leverage EMRs to create fair, risk-adjusted outcomes reports, at least if they have modules that filter for key data points and connect them with non-EMR-based criteria such as a physician’s experience and training.

While this kind of functionality isn’t at the top of hospitals’ must-buy list, they’re likely to end up demanding that EMRs offer such options in the future. I foresee a time when outcomes reporting will be a standard feature of EMRs, even if that means mashing up clinical data with outside sources. EMRs will need to interpret and process information sources ranging from credentialing databases and claims to physician CVs alongside acuity modifiers.

I know that what I’m suggesting isn’t trivial. Mixing non-clinical data with clinical records would require not only new EMR technology, but systems for classifying non-clinical data in a machine-readable and parseable format. Creating a classification scheme for this outside data is no joke, and at first there will probably be intermittent scandals when EMR-generated outcomes reports don’t tell the real story.

Still, in a world that increasingly demands quality data from providers, it’s hard to argue that you can share data with everyone but the patients you’re treating. Patients deserve decision support too.

It’s more than time for hospitals to stop hiding behind arguments that interpreting outcomes data is too hard for consumers and start providing accurate outcomes data. With a multi-million-dollar tool under their roof designed to record every time a doctor sneezes, analyzing their performance doesn’t take magic powers, though it may shake things up among the medical staff.  Bottom line, there’s less excuse than ever not to be transparent with outcomes. And if that takes adding new functionality to EMRs, well, it’s time to do that.