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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 been working with healthcare organizations to implement technologies and improve business processes for nearly twenty years. 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.

Hospitals Using Market-Leading EHR Have Higher HIE Use

Posted on July 29, 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 study concludes that hospital engagement with HIEs is tied with the level of dominance their EHR vendor has in their marketplace. The study, which appeared in Health Affairs, looked at national data from 2012 and 2013 to look at how vendor dominance related to hospitals’ HIE involvement level. And their analysis suggests that the more market power a given vendor has, the more it may stifle hospitals’ HIE participation.

As researchers note, federal policymakers have expressed concern that some EHR vendors may be hampering the free flow of data between providers, in part by making cross-vendor HIE implementation difficult. To address this concern, the study looked at hospitals’ behavior in differently-structured EHR marketplaces.

Researchers concluded that hospitals using the EHR which dominated their marketplace engaged in an average of 45% more HIE activities than facilities using non-dominant vendors. On the other hand, in markets where the leading vendor was less dominant, controlling 20% of the market, hospitals using the dominant vendor engaged in 59% more HIE activities than hospitals using a different vendor.

Meanwhile, if the dominant EHR vendor controlled 80% of the market, hospitals using the leading vendor engaged in only 25% more HIE activities than those using a different vendor. In other words, high levels of local market dominance by a single vendor seemed to be associated with relatively low levels of HIE involvement.

According to the study’s authors, the data suggests that to promote cross-vendor HIE use, policymakers may need to take local market competition between EHR vendors into consideration. And though they don’t say this directly, they also seem to imply that both high vendor dominance and low vendor dominance can both slow HIE engagement, and that moderate dominance may foster such participation.

While this is interesting stuff, it may be moot. What the study doesn’t address is that the entire HIE model comes with handicaps that go beyond what it takes to integrate disparate EHR systems. Even if two hospital systems in a market are using, say, Cerner systems, how does it benefit them to work on sharing data that will help their rival deliver better care? I’ve heard this question asked by hospital financial types, and while it’s a brutal sentiment, it gets to something important.

Nonetheless, I’d argue that studying the dynamics of how EHR vendors compete is quite worthwhile. When a single vendor dominates a marketplace, it has to have an impact on everyone in that market’s healthcare system, including patients. Understanding just what that impact is makes a great deal of sense.

EMR Lawsuit – A Taste Of Things To Come

Posted on July 13, 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 central Pennsylvania health system is embroiled in a court fight with Cerner amid allegations that its EMR technology has created serious patient care problems that could have led to serious harm.

PinnacleHealth, a three-hospital system based in Harrisburg, PA, is blaming series of patient care problems on its Siemens health IT technology, which was acquired by Cerner in February 2015. Apparently, PinnacleHealth had used Siemens as a vendor for 20 years, but when it grew dissatisfied with the platform, cut back its relationship with Siemens and signed a contract with Epic.

Last year, Cerner responded to PinnacleHealth’s actions with a breach of contract lawsuit, asserting that the health system hadn’t paid for services since February 2015. The suit claims that Pinnacle now owes Cerner more than $20 million.

PinnacleHealth, in turn, filed a counterclaim earlier this year in Pennsylvania state court, which seeks damages for Cerner’s alleged fraud and breach of contract. In the counterclaim, it cited several instances of problems it contends were caused by the EMR, including a case in which one patient’s blood pressure dropped dramatically after he was allegedly discharged the wrong medications. It also cites an instance in which a doctor was unable to place a pharmacy order for a newborn to receive vitamin K, a standard step taken to protect babies from serious bleeding.

While some experts are positioning this as the first of a growing number of EMR-related safety disputes, I’d argue that there’s other big issues in play which are more important to consider.

First, though it’s possible the Siemens EMR had problems, it’s impossible to know whether that had more to do with the customer’s unique IT set-up or whether there was an actual tech failure.

That being said, it’s also possible that Cerner missed something during its buyout of Siemens, a risk every vendor who acquires a technology company takes. And EMR vendor consolidation is continuing. If the acquiring vendors move too quickly, or have trouble integrating the new technology into their existing fold, will a growing number of clear-cut cases of EMR failure occur?

Also, it’s important to note that PinnacleHealth is currently battling the FTC for permission to merge with Penn State Hershey Medical Center. Clearly, it needs to have technology in place which can scale and isn’t burdened by 20 years of legacy adoption if the merger goes forward. Admittedly, Penn State Hershey is a Cerner shop, not Epic, but who knows what Penn State Hershey has in mind for HIT if it does get to close the deal?

Yes, there will be some product liability litigation over alleged EMR failures. And in some cases, particularly given the ongoing M&A activity among vendors, someone will drop the ball and bad things will probably happen.

But the most important thing I see happening here is the death knell for older systems in the wake of industry consolidation. I’d keep an eye on mergers between health systems and acquisitions by EMR vendors. Those are the forces that will dictate what happens in the HIT world going forward.

The Rise of the “EHR Value” Equation at Hospitals

Posted on July 1, 2016 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 heard a lot of people talk about how it will be impossible for ambulatory EHR vendors like athenahealth and eCW to break into the acute care market. For those following along at home, both companies have announced that they’re building out their EHR software for the acute care market. These are big bets by both companies, but I think many people don’t realize the advantage these companies will have going into the very expensive hospital EHR market.

Companies like eCW and athenahealth will be able to come into a hospital with a native cloud platform that will let them offer some really aggressive pricing. When you’re paying $50+ million for an EHR (or $9+ billion for some), there’s a lot of wiggle room for a new entrant to enter the fray at a much lower cost point. That lower cost point will totally change the EHR value equation for hospitals. In fact, these cloud based hospital EHR will likely be able to compete effectively against a legacy EHRs upgrade costs alone.

Don’t believe this is possible? Take a look at the story about Delta Regional Hospital returning to MEDITECH. Why did they do it? Thomas Moore, vice president and CFO at Delta said, “We were looking for a system with a lower cost of ownership without sacrificing quality.” Moore later added this comment, “MEDITECH is a company that truly understands the meaning of value.”

During the wild west phase of EHR where the industry was propped up by $36 billion in stimulus money, everyone had the perfect rationale for spending hundreds of millions (and even billions) on EHR software. As we return to a more rational market we’re going to see hospital CIOs starting to place a much larger emphasis on EHR value. Showing that value is going to be hard for some of the larger EHR vendors who’ve charged hundreds of millions and even billions of dollars to their customers. Plus, it will be hard for them to lower their price.

In one online thread I participate on, a bunch of people were bashing Delta Regional Hospital’s decision to go back to MEDITECH. However, a former CIO offered this great insight:

Ya gotta spend time in a Meditech shop. It’s not flashy, but from a value perspective (and it does a lot more than just EHR), it’s hard to beat.

The same is going to be true with acute care EHR from eCW and athenahealth, but they’ll have some of the sexy factor as well. In the acute care EHR world I believe we’re just entering the new world of EHR value. Those who can tell the story of the value they’ve created for customers are going to win. Plus, we’re going to see a fierce battle from new entrants who are going to try and undercut the market. Think about how the EHR value equation changes when you can charge even $75 million instead of $100 million. That’s a game changer.

Hospital Accused Of Firing Nurse For EMR Safety Complaints

Posted on June 29, 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.

The former chief nursing officer of a California hospital is suing her former employer, alleging she was “forced out” of her position after questioning the safety of a little-known EMR donated by a major financial backer of the facility.

The suit filed by nurse Autumn AndRa also names Dan Smith, whose company donated the Harmoni software now used by Sebastopol, CA-based Sonoma West Medical Center. AndRa is claiming that Smith, who has contributed millions in donations and loans to the hospital, has used the hospital as a test bed for his company’s defective system. Smith is president of the medical center’s board of directors.

In an interview with a local newspaper, AndRa said that the Harmoni system has had major problems since the day it went live. Among other issues, the EMR was doing a poor job tracking and updating medications and was “intermingling” medical information between patients, her suit contends. According to AndRa, she went to hospital CEO Ray Hino a week before her dismissal and told him that the system was not safe. (Hino told the newspaper that Harmoni was fine and that no patients had been harmed by the system.)

E-Health Records International Inc., which makes the cloud-based system, primarily serves hospitals outside the U.S., including facilities in the Congo, Jamaica, India and the Philippines. Smith, whose first software development success came when he sold a construction management system to Intuit, serves as the company’s CEO, as well as chairman of telemedicine firm Offsite Care Resources.

Other than that, he seems to have little documented experience as an HIT developer. His other major business venture seems to have been operating a French restaurant with his wife, which he closed after being unable to get back $5.8 million he loaned the hospital.

Regardless of whether AndRa prevails in her suit, I think it’s safe to say that she came out on the wrong end of some questionable political maneuvering by hospital leaders, perhaps including Smith himself. When a hospital is forgiven a large loan, and then fires an executive who raises safety questions about the EMR developed by the lender, eyebrows should be raised.

Epic Install Triggers Loss At MD Anderson

Posted on May 31, 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.

Surprising pretty much no one, another healthcare organization has attributed adverse financial outcomes largely to its Epic installation. In this case, the complaining party is the University of Texas MD Anderson Cancer Center, which attributes its recent shortfall to both EMR costs and lower revenues. The news follows a long series of cost overruns, losses and budget crises by other healthcare providers implementing Epic of late.

According to Becker’s Hospital CFO, MD Anderson reported adjusted income of $122.9 million during that period a 56.6% drop over the seven-month period ending March 31. During that period, the cancer center’s wages and salaries climbed, and Epic-related consulting costs were climbed as well. This follows a $9.9 million operating loss for the first quarter of the 2016 fiscal year, which the University of Texas attributed to higher-than-expected EMR expenses.

MD Anderson announced its choice of Epic in spring 2013, and went live on the system in March of this year as anticipated. The cancer center’s rollout was guided by Epic veteran Chris Belmont, the center’s CIO, who implemented Epic across 10 hospitals and more than three dozen clinics for New Orleans-based Ochsner Health System.

The organization didn’t announce what it was spending on the Epic install, but we all know it doesn’t come cheap. However, one would think the University of Texas health system could afford the investment. According to EHR Intelligence, the Texas health system ranks in the 99th percentile for net patient revenue in the US, with total revenue topping $5.58 billion.

And UT leaders seem to have been prepared for the bump, reporting that they’d planned for a material impact to revenues and expenses as a result of the Epic implementation. The system didn’t announce any staff cuts, hiring freezes or other budget-trimming moves resulting from these financial issues.

Having said all this, however, no organization wants to see its income drop. So what actually happened?

For example, when the UT system reports that a drop in patient revenues contributed to the drop in income, what does that mean? Does this refer to scheduled drops in patient volume, planned for ahead of time, or problems billing for services? I’d be interested to know if the center managed to keep on top of revenue cycle management during the transition.

Another question I have is what caused the unanticipated expenses. Did they come from contract disputes with Epic? Unexpected technical problems? Markups on consulting services? Or did the organization have to pour money into the project to meet its go-live deadline? There’s a lot of ways to generate costs, and I’d love to get some granular information on what happened.

Also, I wonder what steps UT leaders will take to avoid unexpected expenses in the future. While it may have learned some lessons from the problems it’s had so far, there’s no guarantee that it won’t face of the costly problems going forward.

If, perchance, and the system has figured out how to stay in the black with its Epic investment, it could sell that secret to cover its IT expenses for years. I’m betting other systems would pay good money for that information!

Appointment Scheduling Site Zocdoc Connects With Epic

Posted on May 25, 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.

In a bid to capture hospital and health system business, appointment scheduling site Zocdoc announced that its customers can now connect the site to their Epic EMRs via an API. The updated Zocdoc platform targets the partners’ joint customers, which include Yale New Haven Health, NYU Langone Medical Center, Inova Health System and Hartford HealthCare. And I’ll admit it – I’m intrigued.

Typically, I don’t write stories about vendors other than the top EMR players. And on the surface, the deal may not appear very interesting. But the truth is, this partnership may turn out to offer a new model for digital health relationships. If nothing else, it’s a shrewd move.

Historically, Zocdoc has focused on connecting medical practices to patients. Physicians list their appointment schedule and biographical data on the site, as well as their specialty. Patients, who join for free, can search the site for doctors, see when their chosen physician’s next available appointment is and reserve a time of their choosing. If patients provide insurance information, they are only shown doctors who take their insurance.

As a patient, I find this to be pretty nifty. Particularly if you manage chronic conditions, it’s great be able to set timely medical appointments without making a bunch of phone calls. There are some glitches (for example, it appears that doctors often don’t get the drug list I entered), but when I report problems, the site’s customer service team does an excellent job of patching things up. So all told, it’s a very useful and consumer-friendly site.

That being said, there are probably limits to how much money Zocdoc can make this way. My guess is that onboarding doctors is somewhat costly, and that the site can’t charge enough to generate a high profit margin. After all, medical practices are not known for their lavish marketing spending.

On the other hand, working with health systems and hospitals solves both the onboarding problem and the margin problem. If a health system or hospital goes with Zocdoc, they’re likely to bring a high volume of physicians to the table, and what’s more, they are likely to train those doctors on the platform. Also, hospitals and health systems have larger marketing budgets than medical practices, and if they see Zocdoc as offering a real competitive advantage, they’ll probably pay more than physicians.

Now, it appears that Zocdoc had already attracted some health systems and hospitals to the table prior to the Epic linkage. But if it wants to be a major player in the enterprise space, connecting the service to Epic matters. Health systems and hospitals are desperate to connect disparate systems, and they’re more likely to do deals with partners that work with their mission-critical EMR.

To be fair, this approach may not stick. While connecting an EMR to Zocdoc’s systems may help health systems and hospitals build patient loyalty, appointment records don’t add anything to the patient’s clinical picture. So we’re not talking about the invention of the light bulb here.

Still, I could see other ancillary service vendors, particularly web-based vendors, following in Zocdoc’s footsteps if they can. As health systems and hospitals work to provide value-based healthcare, they’ll be less and less tolerant of complexity, and an Epic connection may simplify things. All told, Zocdoc’s deal is driven by an idea whose time has come.

From Epic Staffer To Epic Consultant

Posted on May 11, 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.

Since many readers may have considered such a move, I was interested to read an interview with a woman who had transitioned from an Epic-based staff position at hospital to a consulting gig. Here are some of the steps she took, which offer food for thought for those who might want to follow in her footsteps.

Prior to going into Epic consulting, Pam (no last name given) had worked full time as a Clindoc/Stork analyst, specializing in Reporting Workbench and Radar dashboards. The hospital where she worked with deploying Epic for the first time as their EMR solution, a three-year project spanning 14 hospitals in her health system. Prior to that, Pam had worked in both IT and in the ICU as an RN.

Before she agreed to take the consulting position, which requires her to travel to the northeast once a week, Pam weighed the effect all the required travel would have on her spouse and family, as well as her elderly parents and in-laws.

She also bore her financial situation in mind. While she knew she could earn more as an Epic consultant than she could as a staff member, she also wouldn’t have access to company benefits such as retirement plans, health insurance, and paid sick days and vacation time. (Now that she’s consulting, Pam works with a financial analyst to create a personal retirement plan.)

To market herself as a consultant, Pam began by updating a resume to reflect the most current experience, including, obviously, her Epic experience. She researched Epic consulting firms in sent her resume to those that seemed appropriate. She also pulled together her personal and professional references, getting their permission to be contacted by firms interested in learning more about her. Then she worked with recruiters and consulting firms to capture her desired position.

One cautionary note from her story: Despite her experience level, as well as her having obtained in additional Epic proficiency and badge, she didn’t get a job immediately. In fact, it took her seven months to find an opportunity that fit her skills, a period she calls “long and difficult.” But she tells the interviewer that all the effort was worth it.

A few comments from the peanut gallery: While Pam has done well, the ending of the story — that she ended up waiting nearly a year to get her Epic job — came as a surprise to me. Yes, we are not in the absolute heyday of Epic consulting, as we were a few years ago, I would’ve assumed that an experienced professional with both clinical and IT background would’ve been snapped up much more quickly.

After all, while most hospitals may have made their big initial EMR outlay, maintaining those bad boys is an ongoing issue, and last I heard few have the resources to do so without outside help. Not only that, I doubt Epic has begun to hand out certifications like fortune cookies.

So why would there be a glut of Epic consultants, if there is in fact one? All I can think is that 1) the prevalence of Epic installations has led to more trained people being available, and 2) that hospitals have figured out how to maintain their Epic systems without as much outside help as they once had.

Either way, there may be a warning in this otherwise upbeat story. If you are thinking about hanging out your shingle as a Epic consultant, you may want to check out demand before you do. You may also want to spend some time searching through the Epic and other Healthcare IT jobs on Healthcare IT Central.

Mayo Clinic’s Shift To Epic Eats Up Most of IT Budget

Posted on May 6, 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.

Mayo Clinic has announced that it will spend about $1 billion to complete its migration from Cerner and GE to Epic. While Mayo hasn’t disclosed they’re spending on software, industry watchers are estimating the agreement will cost hundreds of millions of dollars, with the rest of the $1 billion seemingly going to integration and development costs.

The Clinic said in 2014 that it would invest $1.5 billion in IT infrastructure over multiple years, according to the Minneapolis/St. Paul Business Journal. Then last year, it announced that it would replace Cerner and GE systems with an Epic EMR. Now, its execs say that it will spend more than $1 billion on the transition over five years.

Given what other health system spend on Epic installations, the $1 billion estimate sounds sadly realistic. Facing up to these costs is certainly smarter than lowballing its budget. Nobody wants to be in the position New York City-based Health and Hospitals Corp. has gotten into. The municipal system’s original $302 million budget expanded to $764 million just a couple of years into its Epic install, and overall expenses could hit $1.4 billion.

On the other hand, the shift to Epic is eating up two thirds of the Mayo’s $1.5 billion IT allowance for the next few years. And that’s a pretty considerable risk. After all, the Clinic must have spent a great deal on its Cerner and GE contracts. While the prior investments weren’t entirely sunk costs, as existing systems must have collected a fair amount of data and had some impact on patient care, neither product could have come cheaply.

Given that the Epic deal seems poised to suck the IT budget dry, I find myself wondering what Mayo is giving up:

  • Many health systems have put off investing in up-to-date revenue cycle management solutions, largely to focus on Meaningful Use compliance and ICD-10 preparation. Will Mayo be forced to limp along with a substandard solution?
  • Big data analytics and population health tech will be critical to surviving in ACOs and value-based payment schemes. Will the Epic deal block Mayo from investing?
  • Digital health innovation will become a central focus for health systems in the near future. Will Mayo’s focus on the EMR transition rob it of the resources to compete in this realm?

To be fair, Mayo’s Epic investment obviously wasn’t made in a vacuum. With the EMR vendor capturing a huge share of the hospital EMR market, its IT leaders and C-suite execs clearly had many colleagues with whom they could discuss the system’s performance and potential benefits.

But I’m still left wondering whether any single software solution, provided by a single vendor, offers such benefits that it’s worth starving other important projects to adopt it. I guess that’s not just the argument against Epic, but against the massive investment required to buy any enterprise EMR. But given the extreme commitment required to adopt Epic, this becomes a life-and-death decision for the Mayo, which already saw a drop in earnings last year.

Ultimately, there’s no getting past that enterprise EMR buys may be necessary. But if your Epic investment pretty much ties up your cash, let’s hope something better doesn’t come along anytime soon. That will be one serious case of buyer’s regret.

Telemedicine A Growing Priority For Hospitals

Posted on April 29, 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.

Telemedicine programs are not new to hospitals. In fact, tele-stroke and tele-ICU programs have gained significant ground over the past several years, and other subspecialties, such as tele-psychiatry, seem likely to grow in popularity.

In coming years, telemedicine will go from being a one-off strategy to an integral part of hospital care delivery, if a new survey is any indication. Government and private insurers are gradually agreeing to pay for telemedicine services, knocking down the biggest obstacle to rolling out such programs. And while integrating telemedicine services with EMRs poses major challenges, hospital leaders seem determined to address them.

Virtually all of the hospitals responding to the survey, which was conducted by telemedicine vendor ReachHealth, told researchers that they were busy planning and preparing for telemedicine programs. Twenty-two percent of survey respondents, which also included some medical practices, said that rolling out telemedicine programs was one of their top priorities, and another 44% said that it was a high priority. Health systems averaged 5.51 telemedicine service lines, up almost 20% from last year.

I was interested to note that 96% of respondents were planning to roll out telemedicine because they felt it would improve patient outcomes. I’m not aware that there’s any substantial body of evidence demonstrating that telemedicine can have this effect, but clearly this is a widespread belief.

Also, it was a bit surprising to read that “improving financial returns” was a very low priority for providers when developing telemedicine programs. On the other hand, as researchers point out, hospitals and practices to see improved patient satisfaction as a driver of ROI. Apparently, execs responding to this survey are convinced that telemedicine to have a substantial effect on satisfaction and outcomes, though to date, only 55% said telemedicine was improving outcomes and 44% felt it was boosting patient satisfaction.

Researchers also found that providers that dedicate more resources to telemedicine are seeing more success than those that don’t. Specifically, hospitals and clinics that have a 100% dedicated telemedicine program manager in place were doing better with their initiatives.

In fact, two thirds of respondents with a dedicated program manager in place ranked their efforts to be “highly successful,” while only 46% of programs without a dedicated program manager met that description. (The programs were most successful when a VP or director was put in charge of telemedicine efforts, but only slightly more than when a CEO or coordinator was in charge.)

That being said, it seems that the highest barriers to telemedicine success are technical. The respondents complained that the lack of common EMR in hub and spoke hospitals, and the lack of integration between telemedicine and their current EMR, were still standing in their way. Many were also concerned about the lack of native telemedicine capabilities in their EMR.

Despite all of the obstacles to creating a flourishing telemedicine program, hospitals and clinics have continued to make progress. In fact, 36% have had a tele-stroke program in place for more than three years, 23% tele-radiology for three years plus, and 22 percent have had neurology and psychiatry telemedicine programs for three years or more. ReachHealth researchers note that service lines requiring access to specialists are growing more rapidly than other service lines, but contend that this is likely to shift given pending shortages of primary care physicians.

Admittedly, any survey published by telemedicine vendor is likely to be biased. Still, I thought these statistics were worth discussing. Do they track with what you’re seeing out there? And do you think EMR vendors will do more to support telemedicine anytime soon?