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Cerner Tops List Of Hospital Vendors For Medicare EHR Incentive Program

Posted on September 28, 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.

Research from the ONC concludes that Cerner systems are in use by the most hospitals using certified technology to participate in the Medicare EHR Incentive Program. It’s interesting to note that this list includes players that rarely appear on overall lists of top hospital EHR vendors, though admittedly, there’s no one way to measure market dominance that produces consistent results every time.

According to ONC statistics, there were 175 vendors supplying certified health IT to 4,474 nonfederal acute-care hospitals participating in the Medicare EHR Incentive Program. Ninety-five percent of these vendors have 2014 certified technology.

The report notes that six of these vendors (Cerner, Meditech, Epic, Evident, Medhost and McKesson) provide 2014 certified technology 92% of hospitals using the technology. When you throw in athenahealth, Prognosis and QuadraMed, bringing the list to 10 vendors, you’ve got a group that supplies 2014 technology to 98% of eligible hospitals.

According to the data, the vendors at the top fall in as follows. Cerner tops the list of total hospitals using its certified health IT, with 1,029 hospitals;  Meditech was next with 953 hospitals; Epic came in third with 869 hospitals; CPSI’s Evident (formerly Healthland) was fourth with 637 hospitals; McKesson fifth with 462 hospitals; and Medhost sixth with 359 hospitals.

As is usually the case with any attempt to look at market share, the data comes with its own quirks. For example, when looking at ONC’s data as of July 2016 on ambulatory healthcare providers choice of certified technology, Epic was way ahead of the pack with 83,674 users. Allscripts came in at a distant second with 33,123 users. Cerner came in sixth with 15,100 ambulatory users. In other words, vendors one might class as “enterprise” focused are doing well among clinicians. (See more data along these lines in a Medscape survey I summarized previously.)

Then consider data from HIMSS Analytics, which concludes that Epic has 40% of the hospital health IT market, followed by Cerner at a distant second with 13%, Allscripts at 10%, Meditech at 7% and eClinicalWorks at 5% and NextGen with 4%. Why the big difference in numbers? It seems that HIMSS Analytics includes the size of the hospital in its calculations versus the ONC data above which talks about the number of hospitals.

No doubt the buying patterns vary when you look at the number of beds a hospital has. For example, according to research done last year by peer60, CPSI and eClinicalWorks held the biggest share of the market among facilities with less than 100 beds, MEDITECH, McKesson and Siemens dominated the mid-sized hospital categories, and as the number of beds rises from 250 to 1000+ plus, Cerner and Epic emerge as the top players.

The truth is, market share numbers are interesting, and not just to the vendors who hope to emerge on top. Everyone loves a good horse race, after all. But it’s good to take these numbers with a large dose of context, or they mean very little.

Study: Hospital EMR Rollouts Didn’t Cause Patient Harm

Posted on September 14, 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.

Rolling out a hospital EMR can be very disruptive. The predictable problems that can arise – from the need to cut back on ambulatory patient visits to the staff learning curve to unplanned outages – are bad enough. And of course, when the implementation hits a major snag, things can get much worse.

Just to pull one name out of a hat, consider the experience of the Vancouver Island Health Authority in British Columbia, Canada. One of the hospitals managed by the Authority, which is embroiled in a $174 million Cerner implementation, had to move physicians in its emergency department back to pen and paper in July. Physicians had complained that the system was changing medication orders and physician instructions.

But fortunately, this experience is definitely the exception rather than the rule, according to a study appearing in The BMJ. In fact, such rollouts typically don’t cause adverse events or needless deaths, nor do they seem to boost hospital readmissions, according to the journal.

The study, which was led by a research team from Harvard, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, looked at the association between EHR implementation and short-term inpatient mortality, adverse safety events or readmissions among Medicare enrollees getting care at 17 U.S. hospitals. The hospitals selected for the study had rolled out or replaced their EHRs in a “big bang”-style, single-day go-live in 2011 and 2012.

To get a sense of how selected hospitals performed, the team studied patients admitted to the studied facilities 90 days before and 90 days after EHR implementation. The researchers also gathered similar data from a control group of all admissions during the same period by hospitals in the same referral region. For selected hospitals, they analyzed data on 28,235 patients admitted 90 days before the implementation, and 26,453 admitted 90 days after the EHR cutover. (The control size was 284,632 admissions before and 276,513 after.)

Apparently, researchers were expecting to see patient care problems arise. Their assumption was that in the wake of the go-live, the hospitals would see a short increase in mortality, readmissions and adverse safety events. One of the reasons they expected to see this bump in problems is that some negative problems related to time and season, such as the “weekend effect” and the “July effect,” are well documented in existing research. Surely the big changes engendered by an EHR cutover would have an impact as well, they reasoned.

But that’s not what they found. In fact, the researchers wrote, “there was no evidence of a significant or consistent negative association between EHR implementation and short-term mortality, readmissions, or adverse events.”

I was as surprised as the researchers to learn that EHR rollouts studied didn’t cause patient harm or health instability. Considering the immense impact an EHR can have on clinical workflow, it seems strange to read that no new problems arose. That being said, hospitals in this group may have been doing upgrades – which have to be less challenging than going digital for the first time – and were adopting at a time when some best practices had emerged.

Regardless, given the immense challenges posed by hospital EHR rollouts, it’s good to read about a few that went well.  We all need some good news!

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.

Hospitals Struggle To Use EHRs To Report eCQMs

Posted on July 18, 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 by CMS has found that hospitals are struggling to use their EHRs to report electronic clinical quality measures. The agency found that while EHRs helped contractors collect data remotely using hospital staffers, EHR platforms “had not yet matured” enough to meet the specs required, according to Managed Care magazine.

The CMS findings came from a validation pilot study of eCQMs. The goal of the pilot study was to evaluate approaches for validating eCQMs for the Hospital Inpatient Quality Reporting program.

The program, which was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, authorized CMS to pay hospitals a higher annual update to their payment rates if they successfully reported designated quality measures. Later legislation mandated that Medicare hospitals that don’t successfully report would be hit with a 2.0% reduction in the annual rate of inflation used to calculate payment.

One might guess that putting EHRs in place would help hospitals comply. But it appears that this is not been the case in many instances. In fact, hospital IT leaders are facing some significant challenges in linking EHR data to the required reporting format.

To accurately report eCQMs, hospitals must create complete and accurate Quality Reporting Data Architecture (QRDA)-I files based on 2014 eCQM specifications. But hospitals reported that they were having a hard time mapping the information in the EHR systems to the QRDA-I specifications, particularly given the use of unstructured data fields and multiple source of information for various events, Managed Care reported. Measures match rates, in turn, were rather low, ranging from 12% to 49%.

The hospitals involved in the pilot also said that data mapping and workflow issues were major problems. For example, as it turned out much of the information they needed was locked up in free text, notes or scanned documents rather than discrete data fields. That made it impossible for those hospitals to extract the data and mapping to the elements found in the QRDA-I files.

To solve these problems, pilot hospital reported, CMS should consider addressing three key areas: boost communication, outreach and education to raise hospital and vendor understanding of eCQMs; cut down the burden imposed by eCQM adoption; and offer tools and guidance to help hospitals with eCQM implementation.

As CMS learns, the help hospitals want should be forthcoming. In the report, CMS said that it plans to conduct additional validation pilots in the future. The agency said its goal will be able to help hospitals and vendors transition to eCQM reporting, and over time to increase the accuracy of the data that gets reported.

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.

McKesson Merges Division With Change Healthcare

Posted on July 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.

McKesson Corp. has announced plans to roll the majority of its Technology Solutions business into an independent organization, combining the assets with those of Change Healthcare. McKesson will co-own the new company with Change. Once the deal is complete, execs plan to take the new company public, probably sometime next year.

According to McKesson CEO John Hammergren, the two companies came together to offer a better range of options to providers. “The new company will establish a more efficient suite of end-to-end payment and claims solutions, as well as clinical capabilities,” Hammergren said in a company announcement.

The new entity, which combines most of the Technology Solutions assets with the bulk of the former Emdeon, will have combined total annual revenues of $3.4 billion. When the deal is done, McKesson will own about 70% of the new company, with the remainder held by Change Healthcare stockholders.

McKesson will still hold on to RelayHealth Pharmacy and its Enterprise Information Solutions division for now, but is looking at “strategic alternatives” for the EIS division. Change Healthcare, for its part, is keeping its pharmacy switch and prescription routing businesses, which will continue to be held by the current Change stockholders.

The deal could wring new profits out of a McKesson division which has seen better days, observers say.

The last few years have been tough for McKesson which, as HIStalk notes, has seen a growing number of customers going is technology aside in favor of Epic and Cerner solutions. Four years ago, the vendor began shifting resources away from its Horizon Clinicals product line in favor of its Paragon suite. Horizon had been serving several hundred large facilities of 300 beds and up. Since then, McKesson has struggled to convert Horizon customers to Paragon, as gossip heated up that the Atlanta vendor was dialing down Horizon support to force customers onto Paragon.

Now, execs hope the combined company will offer the resources, scalability and integration hospital customers are after. The question is whether even such a large player can challenge Epic and Cerner’s stranglehold on the hospital market. If nothing else, it will have to battle perceptions that it can’t offer the best tool for the larger hospital systems, HIStalk points out.

Still, even if it doesn’t win Epic or Cerner shops, leaders of the news spun-off entity expect to cast a wider net. Execs hope combined set of financial and payment solutions the attractive to help plan as well as providers.

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.

Creating Alliances with Large Health IT Vendors – Benefits and Challenges

Posted on June 13, 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.

Healthcare Scene recently sat down with Nancy Hannan, Philips Relationship Director at Augusta University Health System (formerly known as Georgia Regents) to talk about their alliance with Philips Healthcare and the impact it’s had on their healthcare organization.

Along with talking about the benefits and challenges of creating a long term contract with a healthcare IT vendor, we also dive into the details of how medical device standardization has impacted their organization. Not to be left out, we also talk about how this relationship has impacted patients and doctors. If your organization is looking at how to standardize your medical equipment, this interview will give you some insight into creating a long term alliance with your vendor.

In the second part of my interview with Nancy Hannan, Philips Relationship Director at Augusta University Health System (formerly known as Georgia Regents) we discuss how they’re taking the lessons learned from the Philips alliance and applying them to their agreement with Cerner. We also talk about how cybersecurity is better having a vendor representative on site like they have with Philips.

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.