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Cerner, Intermountain Form Major Development Partnership

Posted on October 1, 2013 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.

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.

Hospitals’ Bankruptcy Fueled By EMR Complications

Posted on June 7, 2013 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 theory, after they get through their growing pains, hospitals should be able to leverage EMRs and new billing systems to improve their financial condition.  In the following case, however, the installation of these new technologies seem to have been the straw that broke the camel’s back.

A group of New York hospitals is $200 million in the red, and owes debts to about 3,000 creditors, a fact which came out in the hospitals’ recent bankruptcy filing. Sound Shore Medical Center of New Rochelle, Mount Vernon Hospital and five related entities have only $159.6 million in assets, according to the Healthcare Renewal blog.

Rather than go out of business completely, the hospitals have found a savior in Montefiore Medical Center, which is offering to buy the group for $54 million plus furniture and equipment.

What’s interesting here isn’t another sad hospital bankruptcy, which are all too common these days, but the reasons for the hospitals’ unfortunate financial condition.

One cause is financial bleeding which began way back in 2006, when the hospitals began seeing falling patient volume and a negative change in their case mix.  In recent times the hospitals have been seeing “significant” losses, negative cash book balances and bills  paid more than 225 days late, the blog notes.

All of that being said, the real kiss of death seems to have come in 2011, when the hospital did an EMR and billing system conversion.  Rather than helping matters, the conversion “caused major delays in billing and cash collection that still haven’t been fully solved” two years later.

I didn’t write this story up to trash EMRs or billing system  upgrades, of course. But it is worth noting that EMR installations aren’t just an expense, they’re a threat to a hospital’s financial well-being if things don’t go well.

Many Hospital Executives Expect Big Health IT Investments This Year

Posted on May 8, 2013 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.

Surprise, surprise.  A new report from the Premier healthcare alliance finds that many hospital executives will make their largest capital investments in IT this year.

To prepare the report, known as the spring 2013 Economic Outlook, Premier spoke with 530 survey respondents, most of whom were hospital leaders.  Survey respondents also included materials and practice area managers, reports iHealthBeat.

Roughly 43 percent of respondents said that their health organization’s biggest capital investment over the next year would be in health IT, a jump of 21 percent from two years ago.  Offering a hint on where the money may be going, the report also found that 32 percent of respondents can’t currently share data across the continuum of care.

Other clues as to where the spending is going come from the study’s topline finding, which predicts a big shift from inpatient to outpatient care.

According to Premier, only 35 percent of respondents are expecting to see an increase in inpatient spending this year as compared to 2012, down 30 percent from predictions made last year. Meanwhile, 69 percent of respondents said they expect to see an increase in 2013 outpatient volume compared to last year.

Some additional intelligence from the report:

* 22 percent of respondents are in an ACO, and 55 percent plan to be by the end of next year

* 27 percent don’t have plans to pursue the ACO model, and may look to bundled payment, care management fees or pay for  performance options

*  29 percent said overutilization of products and services and 22 percent said lack of clinical coordination were the biggest drivers of healthcare costs

* 48 percent said reimbursement cuts had the biggest impact on their health systems

* 40 percent said capital spending would increase over the next 12 months as compared with the previous year

* Almost 37 percent project a capital spending decrease

Epic Installation Fuels Maine Controversy

Posted on May 6, 2013 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.

Ordinarily, the fact that integrated delivery system MaineHealth had spent $150 million on an Epic EMR system wouldn’t excite a lot of comment.  After all, say what you like about Epic, it doesn’t come cheaply, and a $150 million install is at the low-ish end of what hospitals are spending to put the vendor’s system in place.

This time, though, the health system is taking fire from the community, in part because it’s decided to close 22-bed St. Andrews Hospital in Boothbay Harbor, reports EHR Intelligence. 

In an open letter published in the Boothbay Register, local selectman and St. Andrews Regional Task Force member Stuart Smith argues that the Epic install cost is “extremely high.”

Smith also notes that Maine Health has had a bad time with the installation, which was supposed to go live on December 1, 2012 and now looks as though it won’t go live until 2015.  As Smith sees it, a lot of money and time is being wasted on the Epic project:

Millions of dollars have been charged to member hospitals and staff time (salaries and mileage) over the past 2–3 years with no benefit. The system failure also adds operational costs going forward that were not planned for and regional consolidation of finance will now be delayed.

As things stand, Smith notes, the planned closure of St. Andrews is part of a larger shuffle moving urgent and emergency services around which has led to roughly $2 million in losses for the facility.

With St. Andrews wobbly, leaders are considering merging it with struggling Miles Memorial Hospital, a combination which could allow its owners to keep $5 million in federal reimbursement by keeping its critical access hospital designation.

Hospital-Backed HIE On The Rocks

Posted on January 2, 2013 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 an all-too-familiar tale of conflict, turf wars and financial doubts, a three-year effort to bring some of the Chicago area’s largest hospitals into an HIE seems on the verge of collapse.

The proposed HIE is backed by the Metropolitan Chicago Healthcare Council, a nonprofit group of about 150 hospitals and healthcare providers. But despite industry backing, the effort hasn’t gotten any momentum. Though the Council has been flogging the HIE concept since 2009, just 18 hospitals and physician groups have agreed to join, according to a report in Crain’s Chicago Business.

In theory, the massive, sophisticated health systems that serve the Chicagoland area would see the value in sharing medical records if anyone would. If nothing else, they’re doubtless thinking about or already participating in risk-bearing ACO contracts, so cutting down on needless duplicated tests would be a plus.

But apparently, potential HIE members are balking at the cost of sustaining the HIE, which can run to six figures annually depending on the institution. Apparently, they’re not sure that they’ll get a decent return on their investment. And of course, there’s little doubt that these systems are already investing many, many millions in EMRs and supporting systems, tying up most if not all of their IT investment budget.

What’s more, while Crain’s doesn’t mention this issue, I’d argue that hospitals are also skittish about cooperating with their competitors. Particularly in an intensely competitive market like Chicago, hospitals and health systems may feel that HIEs are a step too close to the enemy.

Now, even if the major hospitals refuse to invest in the HIE, the Council does have other ways that it might be able to pay for the exchange.  For one thing, the group has begun discussions with health insurers to see if they might be interested in helping to fund it. And there’s always government grants, which are available to help kick off startup HIEs.

The bottom line, though, is that hospitals are still conflicted when it comes to HIE involvement. Though most CIOs say that they’re interested in being involved, financial — and let’s not forget competitive — issues prevent them from getting on board.

New Hospital Rockets To Top Of HIMSS EMR Adoption Scale

Posted on December 26, 2012 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.

Here’s a story of what can happen when a hospital starts out from scratch with the latest in EMR knowledge, rather than having to integrate its system bit by bit.

Texas Health Alliance, a 50-bed acute-care hospital based in north Fort Worth, has been named as achieving the rarely-seen Stage 7 in HIMSS Analytics EMR Adoption Model. At present, only 103 U.S. hospitals, or 1.9 percent, are currently at Stage 7.

Some of the outstanding features of the rollout include:

* Over 95 percent utilization of CPOE (driven predominately by well-designed order set content, HIMSS says)
* Advanced clinical decision support alerts that support best practice protocols
* Smart use of an enterprise data warehouse used to monitor best practice alerts and core measures
* Closed-loop medication administration environment

This award is interesting given that small hospitals have been well behind the curve in Meaningful Use and meeting the HIMSS standards.  But there’s some obvious reasons why it’s been so successful.

For one thing, THA has been open only since September. I’ll bet many readers would kill for the clean slate that offers the IT people there. No need for expensive integration projects to bring the new EMR on board; no having to switch staffers from one technology to another; no major transition from paper to digital; and the list of benefits goes on.

Another major factor working in its favor is that THA is part of nonprofit hospital system Texas Health Resources.

A tiny hospital backed by a sizeable IDN is in a different position entirely than an independent critical access hospital, so it’s not exactly astonishing that it zoomed ahead. And when the parent chain already has its own (Epic) install well under way — and an engaged community of users — that knowledge goes a long way.

Too bad most hospitals can’t start out fresh the way THA did. Innovation always comes easier if it isn’t competing with the stuff you’ve already got.

Oops! Community Hospitals Unhappy With EMR Purchase

Posted on December 18, 2012 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 report from KLAS seems to confirm what we all know already — that buying an EMR is a tricky business that can easily end in failure.  The new KLAS report found that increasingly, community hospitals are questioning whether they bought the right EMR, and that a substantial number are already ripping out and replacing their system.

The authors of the report found that about 200 hospitals with less than 200 beds said they were planning to replace their EMR. And in an even more dramatic turn, KLAS found that one in three community hospitals who’d gone live with their EMR in the past 12 months felt they’d made the wrong decision.

Epic had the most overall community hospital wins for 2011, followed by Healthland, Cerner and CPSI. Looked at another, by market share, Meditech came in first with 20 percent, followed by Epic and Cerner, both with 12 percent.

This ferment comes against a backdrop of bigger institutional changes, in which smaller hospitals are joining integrated delivery networks, and as a result, are being shoehorned into using enterprise systems like Epic and Cerner already in place within the IDNs.

This level of disappointment in technical investments would be pretty remarkable in just about any industry. Given the pressure to get on the Meaningful Use train, it’s perhaps a bit less surprising, since pressure to invest can lead to fatal flaws in just about any decision-making process. Still, as an observer, it alarms me to see just how common EMR dissatisfaction is in smaller community hospitals.

As we’ve noted here before, giant institutions making giant investments seem a lot less prone to expressing dissatisfaction with their EMR.  Maybe it’s because those hospitals really are getting more for their money — who knows? But my guess is that they’ve as prone as smaller hospitals to wish they’d gone another way, given how hard it is to make an enterprise software buy that pleases everybody.

In any event, let’s hope that community hospitals largely make their peace with the EMR they’ve got. Rip and replace can’t be good for morale, finances or patient care.

UPMC Sinks $100MM Into Big Data

Posted on November 6, 2012 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 University of Pittsburgh Medical Center has announced plans to spend $100 million over five years to create a massive data warehouse, a move which puts it well at the forefront of hospital “big data” efforts.

According to Information Week, UPMC’s data warehouse will bring together clinical, financial, administrative, genomic  and other information. The health system has targeted more than 200 data sources across the Medical Center, UPMC Health Plan and other affiliates.

I’ll let Information Week describe the technical set-up:

To collect, store, manage, and analyze the information maintained in the data warehouse, UPMC will use the Oracle Exadata Database Machine, a high-performance database platform; IBM’s Cognos software for business intelligence and financial management; Informatica’s data integration platform; and dbMotion’s SOA-based interoperability platform that integrates patient records from healthcare organizations and health information exchanges. These tools will manage the 3.2 petabytes of data that flows across UPMC’s business divisions.

As to how UPMC plans to use these tools, they’re hoping to do all of the things you might imagine, including genomically-tailored prescribing, population analytics and sophisticated tracking of individual patient data to make predictions about possible risks.

As I see it, UPMC’s efforts highlight both the importance of big data efforts and the downside in making the investment.

On the one hand, you’ve got the benefits. For example, patients will clearly see better outcomes if doctors can use top-drawer analytical tools to predict how treatments will work or know well in advance if a patient’s condition is about to go south.  And hospitals will clearly run better if execs get insights into issues that cross clinical and administrative boundaries, such as ED or OR utilization.

On the other, you’ve got the reality that big data projects are prohibitively expensive for all but the best-funded of healthcare organizations, and probably won’t produce returns on investment for several years at best.  Average community hospitals won’t be consolidating and analyzing their data this way anytime soon.

Allscripts Loses NYC Hospital Deal To Epic, Files Complaint

Posted on October 11, 2012 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.

Usually, battles over a hospital EMR contract fall below the radar, with only the hospital and vendors the wiser as to what took place during negotiations. But this time, we may be treated to the spectacle of seeing a large health system explain, in some detail, why it chose one vendor over another.

Allscripts, which lost an EMR contract for New York City’s public hospital system, is crying foul over the system’s decision to go with Epic.  Allscripts has filed a complaint over the award of the $303 million contract, which involves tying together 11 public hospitals, 70 clinics, thousands of doctors and more than one million patients, The New York Times reports.

Allscripts estimates that over 15 years, when ancillary costs are included, it would cost $1.4 billion to implement Epic, while its own EMR rollout could be completed for less than half that number.

Right now, the contract is on hold, and won’t be in force until Allscripts’ complaint with a procurement-review board within the city’s Health and Hospitals Corporation is resolved. (HHC runs the public hospital system.)

But Alan Aviles, president of the corporation, doesn’t seem like he’s willing to budge. Aviles told the Times that HHC chose Epic after considering nine vendors over four years. And he argues that Allscripts’ recent management and financial troubles only validate HHC’s decision.

And at the end of the day, Aviles simply doesn’t buy Allscripts’ estimates. “Allscripts and its CEO absolutely know that the $700 million [savings] number they tossed out is fallacious,” Aviles said. What’s wrong with their numbers? Well, for one thing, Aviles says, Allscripts estimated that the application-support team needed to implement the EMR would cost nothing over 15 years, while HHC had calculated that 15-year staff support would cost $357 million.

Readers, I don’t know about you, but I think there’s some degree of truth on both sides.  If Allscripts submitted a proposal assuming no support costs for HHC, they must be out of their minds.  At the same time, though, I’ve never heard of a major Epic installation being anything but the most expensive option, bar none. Seems to me the truth lies somewhere in the middle.

Health Management Associates Makes System-Wide Deal With athenahealth

Posted on September 21, 2012 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.

Cloud-based EMR vendor Athenahealth has struck a deal with hospital chain Health Management Associates that its vendor competitors would die for.

HMA has signed an agreement with athena under which the chain’s 1200+ employed physicians — cutting across 15 states and 300 locations — will now use the vendor’s practice management, EMR and patient communication services. HMA’s 10,000-odd independent physicians will also have access to the systems.

In the announcement, HMA and athena took pains to emphasize that the selection process was a fair and thorough one:

Health Management selected athenahealth after a twelve-month review and due diligence process that involved more than 350 clinical experts, including more than 200 physicians. The evaluation process included detailed questionnaires, onsite and virtual demonstrations, site visits, and clinical template shootouts.

Perhaps those details were included to convince observers that the deal didn’t include some kind of payola. I don’t think doctors are going to be too impressed by the IT talk. (If it were me I’d care about only one demonstration — how it worked for me on Day One.)

HMA may not be the country’s largest hospital chain, but it’s still a heavyweight, operating 66 hospitals spanning 10,330 licensed beds. Its hospitals span Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Washington, and West Virginia.

Particularly given its scale, this deal intrigues me for a few reasons. It raises what seem to me to be important questions:

* Is HMA expecting its independent physicians to dump whatever EMR they may already have in place and switch it out for athena?  Or adopt its practice management module instead of what they use now?  That seems, uh, a bit unrealistic?

* I don’t know what enterprise EMR system HMA uses (do you, readers?) but whatever it is, I doubt it will plug seamlessly into to the athena cloud.  How do the IT types at HMA plan to connect the whole schlemiel?

* If the independent physicians don’t want to adopt the athena package, what will HMA do? Club them like baby seals?  Or just accept that a large percentage of its docs aren’t connected?