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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.

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.

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.

Payor Recalls ED EMR After Problem Is Discovered

UnitedHealth Group has voluntarily recalled its emergency department EMR after a bug resulted in doctors’ notes not appearing in medical records, according to a story in Healthcare IT News.

Customers of the EMR, OptumInsight’s Picis ED PulseCheck, are spread across 35 facilities in more than 20 states. These users were notified of the issue — prescription notes not showing upon the prescription or patient chart — back in June, HIN reports.

Picis Inc., which was acquired by UHG in 2010, had already issued six software-related recalls since 2009, according to a Bloomberg report.  Incidents include one case where anesthesia-management software sold nationwide that in one case displayed one patient’s medical information in another patient’s file.

Another problem involved software sold worldwide in which on an unspecified number of occasions, the system failed to display discontinued status on medication orders.  Still others included issues causing failures to display appropriate allergy interaction warning and lock out of administrators, Bloomberg said.

While the recall is doubtless a black eye for Picis, the problems it has had are far from unusual. In fact, according to a study reported in the  Annals of Emergency Medicine, emergency department EMR designs vary widely, with some having problems which can compromise clinician workflow, communication and ultimately quality and safety of care.

October 15, 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.

Should Hospital Associations Choose EMRs?

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

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

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

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

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

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

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

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

October 10, 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.

Leveraging Vendor Neutral Archives Against EHR Vendor Lock In

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

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

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

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

October 3, 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.

Cerner, Intermountain Form Major Development Partnership

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

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

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

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

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

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

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

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

October 1, 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.