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A Meaningful EHR Certification

In many ways this post could be considered a continuation of my previous post on data liberation. I’ve really loved the idea of a creating a meaningful EHR Certification and that could include data liberation. Let’s be honest for a minute. Do any of you find value in the current EHR certification?

You know that a certification is screwed up when it requires certain interoperability standards and then when you go to actually implement the sharing of data between two systems you find out that the two systems are working on two different standards. They are close standards, but close doesn’t count with standards. Many have asked the question, “What did the EHR certification do if it couldn’t test the standard?” I have no answer to that question.

Now imagine we created an EHR certification that actually did require a standard for interoperability. Not a flavor of a standard, or something that closely resembles a standard. I’m talking about a standard. Would hospitals find this useful? I think so.

Another example of a meaningful EHR certification could be certifying that an EHR vendor will not hold your EHR data hostage. Think about how beneficial that would be to the industry. Instead of EHR vendors trying to trap your data in their system, they could focus on providing the end user what they need so the end user never wants to leave that EHR. What a beautiful shift that would be for our industry.

There could be many more things that could be meaningfully certified. However, this would be a simple and good place to start. I have no doubt that some would be resistant to this certification. That’s why those who do become meaningfully certified need to get the proper boost in PR that a meaningful certification should deserve. No EHR vendor wants to be caste as the EHR vendor who can’t figure out the standard and that holds its customers hostage. Yet, that’s what they’re able to get away with today.

What do you think of this idea?

April 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Cerner Agrees To Pay $106M Over Allegedly Defective Software

After years of back and forth, Cerner has settled a dispute with a North Dakota hospital claiming that Cerner’s financial software was defective and didn’t deliver expected business benefits.

Back in April 2012, Trinity Health told the vendor that it was transitioning away from Cerner’s patient accounting software solution and certain IT services provided by Cerner. At the time, it alleged that the patient accounting solution didn’t work right.  Of course, Cerner disputed the allegations, according to its 10-K yearly report.

The two players began arbitration in December 2013, a move which allowed Cerner to collect some payments due from the hospital.  At the outset, Cerner was predicting liability you of up to $4 million, while Trinity anticipated damages totaling $240 million.

Ultimately, the two agreed upon a settlement under which Cerner would pay Trinity $106 million. Interestingly, Trinity is continuing as a client of Cerner for its clinical solutions, something you might not expect under the circumstances.

This is a particularly unusual outcome for a vendor/hospital dispute, because most vendor contracts contain clauses to eliminate “consequential damages,” which limit hospital’s ability to take legal action, notes Trinity attorney Michael Dagley. That being said, there are areas under state and common law provisions of consumer fraud statutes, under which manufacturers cannot misrepresent product capabilities and benefits.

Knowing how hard it is for a hospital to sue a vendor of IT services, it makes you wonder whether the growing number of hospitals dumping their current EMR are doing so because they’re not getting what they want but can’t sue to get their money back.  While it may be heinously expensive, buying a new EMR and installing it is certainly faster than going through years of court proceedings and then having to buy another EMR nonetheless.

March 12, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

2013 Hospital EHR and Health IT Trends

There are a number of amazing milestones and trends happening with EHR and Healthcare IT. I think as we look back on 2013, we’ll remember it for a number of important changes that impact us for many years to come. Here are a few of the top trends and milestones that I’ll remember in 2013.

Epic and Cerner Separate Themselves – This has certainly been happening for a couple of years, but 2013 is the year I’ll remember that everyone agreed that for big hospitals it’s a two horse race between Cerner and Epic. There’s still an amazing battle brewing for the small hospital with no clear winner yet. However, in the large hospital race the battle between Cerner and Epic is on. Epic had been winning most of the deals, but Cerner just gave them a big left hook when Intermountain chose Cerner.

I expect we’re living in an Epic and Cerner world until at least a few years post meaningful use. The job listings on Healthcare IT Central illustrate Cerner and Epic dominance as well.

Near Universal EHR Adoption in Hospitals – I can’t find the latest EHR adoption (meaningful use) numbers from ONC, but the last ones I saw were in the high 80′s. That basically leaves a number of small rural hospitals that likely don’t have much tech infrastructure at all, let alone an EHR. Every major hospital institution now has an EHR. I guess we can now stop talking about hospital EHR adoption and start talking about hospital EHR use?

The Cracks in the Healthcare Interoperability Damn Appear – Interoperability has always been a hard nut to crack in healthcare. Everyone knew it was the right thing to do, but there were some real systemic reasons organizations didn’t go that direction. Not to mention, there was little financial motivation to do it (and often financial disincentive to do it).

With that background, I think in 2013 we’ve started to see the cracks in the damn that was holding up interoperability. They are still just cracks, but once water starts seeping through the crack the whole structure of the damn will break and the water will start flowing freely. Watch for the same with interoperability. Some of this year’s cracks were started with the announcement of CommonWell. I think in response to being left out of CommonWell, Epic has chosen to start being more interoperable as well.

Skinny Data Happens – I was first introduced to the concept of skinny data vs big data at HIMSS 2013 by Encore Health Resources. While I’m not sure if the skinny data branding will stick, the concept of doing a data project with a slice of data that has meaningful (excuse the use of the word) outcomes is the trend in data analytics and it’s going to dominate the conversations going forward.

As I posted on EMR and EHR, Big Data is Like Teenage Sex, but skinny data is very different. Skinny data is about doing something valuable with the data. Sadly, not enough people are doing skinny data, but they all will in 2014.

Hospitals Ignore Consumer Health Devices – Consumer health devices are popping up everywhere in healthcare. We’re quickly reaching the point that consumers can monitor all of their vital information at near hospital grade quality using their smartphone and sometimes an external device. This is a real revolution in medical devices. Many are still making their way through FDA approval, but some have passed and are starting to work on traction.

With all of this innovation, hospitals seemed to have mostly ignored what’s happening. Sure, the larger ones have a few pilot projects going. However, most hospitals have no idea what’s about to hit them upside the head. Gone will be the days of patients going to the hospital to be “monitored.” I don’t think most hospitals are ready for this shift.

December 31, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Kaiser Permanente Branch Joins Epic Network

Though it apparently held out for a while, Kaiser Permanente Northern California has signed on to Epic Systems’ Care Everywhere, a network which allows Epic users to share various forms of clinical information, Modern Healthcare reports.

Care Everywhere allows participants to get a wide range of patient data, including real-time access to patient and family medical histories, medications, lab tests, physician notes and previous diagnoses. The Care Everywhere network debuted in California in 2008, and has since grown to a national roster of more than 200 Epic users.

Many of the state’s major healthcare players are involved, including Sutter Health, as well as prominent regional players such as Stanford Hospital and Clinics, USCF Medical Center and UC Davis Health System, according to Modern Healthcare. Kaiser Permanente Southern California also participates in the network.

According to Epic, the Care Everywhere system allows patients to take information with them between institutions whether or not both institutions use the Epic platform. Information can come from another Epic system, a non-Epic EMR that complies with industry standards, or directly from the patient.

But of course, the vendor likes to see Epic-to-Epic transmission best, as it notes on the corporate site: “When an Epic system is on both sides of the exchange, a richer data set is exchanged and additional conductivity options such as cross-organization referral management are available.”

Care Everywhere also comes with Lucy, a freestanding PHR not connected to any facility’s EMR system. According to Epic, Lucy follows patients wherever they receive care, and gathers data into a single source that’s readily accessible to clinicians and patients. Patients can enter health data directly into Lucy or upload Continuity of Care Documents from other facilities.

While connecting 200+ healthcare organizations together is a notable accomplishment, Care Everywhere is not going to end up as the default national HIE matter how hard Epic tries. As long as the vendor behind the HIE (Epic) has a strong incentive to favor one form of data exchange over another, it cuts down the likelihood that you’ll have true interoperability between these players. Still, I’ve got to admit it’s a pretty interesting development. Let’s see what healthcare organizations have to say that try to work with Care Everywhere without owning an Epic system.

P.S. It’ll also be interesting to see whether Epic is actually “best” for ACOs, as a KLAS study of a couple of years ago suggested. More recent data suggests that best-of-breed tools will be necessary to build an ACO, even if your organization has taken the massive Epic plunge.

December 26, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Cerner Forced To Pay Out Large Settlement To Customer

Cerner has struck a settlement agreement with one of its customers which will force the giant IT vendor to take significant charge against its fourth-quarter earnings.

The client, Trinity Medical Center of Minot, N.D., claimed last year that the patient accounting software sold by Cerner in 2008 was defective and didn’t deliver on the promised business benefits.

In the suit, the medical center asked for $240 million in damages, while Cerner only estimated damages of $4 million.  To settle the matter, the two parties agreed to go into arbitration, according to a report in the Wall Street Journal.

While the amount of the settlement was not disclosed in court filings, Cerner clearly got its clock cleaned. The vendor issued a statement saying that it “strongly disagreed” with the amount the hospital was awarded.

As a result of the arbitration settlement, Cerner will take a charge of $0.18 to $0.19 per share for the quarter ending Dec. 23, 2013. Clearly, Cerner came out on the wrong side of the deal, and then some. And it’s not used to losing. The vendor’s statement also noted that this settlement was “the only material judgment against Cerner in its 34-year history.”

While both Cerner and Wall Street will get over this matter, it’s still something of a landmark in the IT vendor business. Most of the time, IT vendor contracts have customers so tied up in knots that they can’t even speak about their experiences with the product, much less take the vendor to court for for poor product performance.

December 17, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

What Can Go Wrong With An Epic Implementation

With Epic owning the lion’s share of new EMR implementations — it has as many in progress or planned as all other major vendors combined — it’s good to stop and look at just what can go wrong with an Epic implementation.

After all, while Epic installations are a fact of life, all of the news they generate isn’t good. In fact, a growing number of stories of botched Epic installs and institutional fallout are beginning to mount.

In an effort to do learn more about Epic’s strengths and weaknesses, researchers at The Advisory Board Company interviewed some of Epic’s most experienced U.S. hospital customers, as well as some of the busiest Epic implementation consultants, writes senior research director Doug Thompson.

As Thompson points out, the problems Advisory Board identified could impact any big EMR install, but with Epic in the lead, it doesn’t hurt to focus on its products specifically.  (By the way, according to the Advisory Board, there were 194 Epic installs in process or contracted for 2012 and 2013; the closest competitor, MEDITECH, had 59 and Cerner came in at 55.)

So what’s behind the stumbling? Thompson names several limitations to Epic’s own approach to implementation, including the following:

* Its young implementation staffers may be enthusiastic, but some lack operational experience in hospitals or medical practices, which means they rely heavily on Epic’s standard methods and tools –and that may not be adequate for some situations.

* Though Epic’s recommended implementation staffing numbers are higher than that of most other EMR vendors, their estimate nonetheless falls short often by 20 percent to 30 percent of the need.

*Epic’s “foundation” (model) installation plan limits customization or extensive configuration until after the EMR has gone live, which can lead to less physician buy-in and end-user cooperation.

To address these concerns, Thompson offers fourteen techniques to help hospitals get the value they want.  Some of my favorites include:

Begin with the end in mind: Make sure your facility has specific, measurable benefits they hope to achieve with your Epic implementation, and prepare to measure and manage progress in that direction.

Governance: Make sure you assign appropriate roles and responsibilities in managing your Epic rollout and ongoing use. While IT will serve as the linchpin of the project, of course, it’s critical to make sure the appropriate operations leaders have a clear sense of how Epic can and should affect their areas of responsibility.

Get outside input on project staffing: While Epic is upfront about the need for extensive staffing in its implementation, as noted its estimates still come in rather low. It’s a good idea to get in objective outside estimate as to how big the project staff really needs to be.

For more information, I highly recommend you read the full Advisory Board brief. But in short, as  the report concludes, it seems that relying too much on Epic’s approach, staff and tools can lead to problems. Surprised?

December 9, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Has Epic Grown Too Big, Too Fast?

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

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

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

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

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

November 8, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Epic Implementation Problems Lead To Lower Hospital Credit Rating

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

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

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

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

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

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

November 7, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

EMRs Now A Patient Draw At Hospitals

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

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

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

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

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

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

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

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

November 5, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Embattled Hospital Relies On Epic To Help Acquisition

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

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

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

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

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

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

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

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

October 28, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.