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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 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

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.

How Danish Leaders Are Choosing Their EMR

Posted on February 19, 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 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

This is something you don’t see every day. Courtesy of my always-on-top-of-things colleague John, here’s a look at the process by which Danish government authorities are selecting an EMR for the Capital Region of Denmark.

As the TBKConsult blog notes, this is a big decision. The authorities expect to spend 135 million euros on the EMR, which will have 40,000 IT users and need to support up to 12,000 clinical and administrative users at 17 hospitals and 54 other healthcare institutions simultaneously. Once installed, the system will support a region serving 2.5 million patients.

Once chosen, the EMR will be implemented with a pilot in the Capital region and eventually, by the end of 2016, rolled out throughout Eastern Denmark.

The selection process has already narrowed down the list of possibilities to five prequalified vendors: Systematic, Epic, Cerner, Cambio and Siemens.  None of the vendors have submitted official proposals yet.

What’s interesting about this isn’t the shortlist, but the means by which the authorities have decided to narrow the list down. Here’s their list of fourteen criteria by which TBKConsult expects them to do so:

  • Installed base and references
  • Clinical reputation
  • HIMSS/EMRAM level 6/7 certifications (Electronic Medical Record Adoption Model)
  • Fit for purpose – clinical processes
  • Fit for purpose – PAS
  • Fit for purpose – external integration
  • Software scalability – current installed base
  • Software scalability (SIG test)
  • Software maintainability (SIG test)
  • Price/Performance
  • Implementation capability
  • Product strategy and influence
  • Political preference
  • Staff perks and community participation

TBK Consult has also ranked the importance of each of these criteria, assigning the most weight to “Fit for purpose-clinical processes” (25 percent), “Fit for purpose-PAS” (15 percent) and “Fit for purpose-external integration” (15 percent). They rated “Implementation capability” at 10 percent and most of the rest of the criteria at 5 percent.

By their weights and ranking, vendor Cambio comes in first, Systematic second, Epic third, Cerner fourth and Siemens fifth. Intriguing. I wonder how close TBK will be when the actual results are announced?

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 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

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?

Top HIS Vendors By 2011 Revenue: Siemens (SI)

Posted on April 30, 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 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

As some of you may recall, a few months ago we took a look at Soarian’s prospects for taking some of Epic’s ever-growing EMR marketing share.  At the time, we noted that Soarian’s  customer satisfaction ratings were climbing and its list of big deals was growing.  In the wake of our story a few readers chimed in to slam Sorian, hard — one dubbed it “the most asinine and ridiculously slow system. Ever.” — but with Siemens’ $85 billion behind it, it’s not going anywhere soon.

So,  here’s some stats on Siemens’ position on the HIS market, courtesy of HealthDataManagement magazine.  As previously noted, HDM defines HIS as the complete package of hardware, software and implementation needed to manage and support a hospital.

HDM has ranked Siemens as third in volume, behind McKesson (#1) and Cerner (#2). HDM estimates that Siemens has 14 percent of the HIS market.

All that being said, bear in mind that we’re  not suggesting the order in which their revenue streams are ranked implies that, say, McKesson offers better products then Cerner. But numbers like these are interesting anyway, aren’t they?  At least in that rubbernecking-can’t-turn-away-from-that-car-crash way…

-Anne Zieger 


Siemens AG (SI)
Wittelsbacherplatz 2
(Phone) +49-89-63600

CEO: Peter Loescher

CEO of Healthcare Sector: Hermann Requardt

2011 HIS Revenue:
$1.7 billion

2010 HIS Revenue: $1.6 billion

Clearly, Siemens wouldn’t go out of business any time soon if it dropped the entire HIS business into a black hole.  $1.7 billion isn’t chump change but it’s a tiny part of the 85 billion Euro company’s overall revenues.

Ah, but for readers of this publication, there’s a catch. Soarian seems to be set up for growth, if the consultants behind HDM’s research are right. According to them, Soarian continues to sell well, and what’s more, with many clients still using Siemens’ older Invision and MedSeries4 systems, Siemens has many prospects that could be sold on a Soarian upgrade.  If so, we could see some real rumbling in the power structure of the EMR business overall.

Interesting fact:  While most of its competitors are firmly rooted in the healthcare business, Siemens is as much (if not more) an electronics and electrical engineering company with very large stakes in power generation, renewable energy, oil and gas, power transmission and distribution.

Medsphere Makes Varied Pitch for Open Source EMRs

Posted on November 30, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Historically, most of the arguments for using open source software of any kind revolve around cost and stability (e.g. free software is as cheap as it comes, and you can’t find a bigger dev team than the entire open source community).  But at a recent conference backed by an open source EMR vendor, some hospital IT folks argued that open source tech can offer much more.

At Brooklyn-based Lutheran Medical Center,  a 476-bed teaching hospital, execs plan to attest to meeting Meaningful Use Standards in early 2012.  They’re doing so using Medsphere’s OpenVista, which as most readers would know is the daughter of the Veterans Affairs’ VistA platform.

According to LMC CEO Wendy Goldstein, using OpenVista has been critical in preparing for MU attestation.  As with other enterprise-level open source users, Goldstein likes having access to the source code, she told the audience at Medsphere-backed Meaningful Use NOW conference. ( That certainly makes sense, given the pace at which regulatory demands on hospitals are shifting.)

We already know about open source software’s pricing and development advantages, but is that  OpenVista’s only advantages? Perhaps not.

Medsphere claims that open source EMRs are better for taking on huge tasks such as transforming workflow and business processes, an intriguing if as-yet-unproven claim.  Does having access to the source code really make a big difference in how effectively hospitals can customize their EMR?  I’d argue that the jury is still out on that one.

And Meaningful Use NOW speaker Bill Petasnick of Wisconsin’s Froedtert Health System argued that the best way to unify health IT platforms across various organizations might be to use an open source, open-architecture solution.  That may not be realistic from a market perspective, but it’s worth considering. Wouldn’t it be nice if some of the silos fell down?

— P.S.  Want to follow up and check some platforms out?  Check out this list of open source health IT options.

Why U.S. Enterprise Health IT Companies Struggle for Success in Europe

Posted on November 22, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The U.S. market for new sales of enterprise health information technology (HIT) in large hospitals is dwindling, despite the incentives heaped upon the market by the Health Information Technology for Economic and Clinical Health (HITECH) Act. While buying has picked up a bit, this uptick is universally acknowledged as a short-term blip which will run its course as timelines expire and federal funds are depleted. For U.S. vendors of HIT, a logical question arises, “where do we go next?”

The Middle East garners some attention, but Europe is a natural choice for market expansion given the comparable standard of living and adoption of technology. Yet, despite years of effort and millions of dollars invested there, U.S. companies struggle to gain a real foothold in Europe.

All Politics is Local

Each country in Europe has its own healthcare climate due to differing approaches to healthcare administration. For example, France would seem to be an inviting market due to its size, amount of money dedicated to the healthcare system, and relatively high proportion of private hospitals. However, U.S. companies unexpectedly struggle to make inroads due to the strong French preference for a local company with local staff. If foreign companies want to sell there, whether American or European, the company must have a local office with local executives, at the least.

Italy also represents a large market, but does not represent a single HIT market. The healthcare governance system has, in effect, created twenty regional markets where each administrative zone has authority to set unique rules and guidelines, thereby influencing vendor selection criteria and funding capacities. Vendors which decide to build a presence in Italy will need to create regional strategies for each administrative zone.

The Right Price

Compared to their counterparts in the U.S., hospitals in Europe typically purchase enterprise HIT at a significantly lower cost. These prices range widely depending on geographic region and hospital type. Also, because of political issues with local, national, and European Union tender processes, the sales cycle can take two to three times longer than even the largest IDN deals in the U.S.

Hospitals in the Netherlands expect to pay a price that is nearly on par with what a comparable hospital in Canada would spend on an enterprise solution. Yet, across the border in next-door Germany, that same product would have to be priced nearly eighty percent lower for consideration.

Relative HIT Prices for Large Hospitals

HIT Priorities Vary

European hospitals have a set of functional priorities which diverge from the priorities which U.S. hospitals have. The following are a few of the more prominent examples:

  • Nursing: While CPOE is a huge priority in the U.S. and a centerpiece of meaningful use initiatives, European hospitals and vendors have focused more attention on automating nursing functions. That is not to say they do not have physician ordering tools, which they do, but nursing has been more of a priority.
  • Closed-loop medication administration: U.S. vendors would be treated as second-rank if they did not have closed-loop capability with tightly interwoven pharmacy functionality. Not so in Europe where lack of closed-loop is fairly common and is not a high priority during the tender process.
  • Connectivity: Beyond robust data flow within a hospital, sharing clinical information regionally within countries has long been a priority in Europe. Several countries have constructed digital spines to which vendors must connect in order to allow client hospitals to share clinical patient information with other hospitals, regions and government agencies.

Who has crossed the pond?

No U.S. firm has yet to find cross-national success in Europe with enterprise clinical solutions. The best-selling large-hospital vendors in the U.S., Cerner and Epic, have found very limited success in promoting their clinical application suites to European hospitals. Cerner initially won business with the NHS Trust in the UK, but those implementations were not particularly successful. Epic seems committed for the long haul in Northern Europe but its growth has been modest thus far. McKesson seems to be withdrawing from certain European markets, and Meditech isn’t spoken of much in Europe. Some U.S. companies may decide to acquire their way into Europe, like CSC is doing via the acquisitions of Scandihealth and iSOFT. Despite the challenges, this much is certain: U.S. HIT firms must continue to explore and expand in Europe as the U.S. matures into a total replacement market. The key, as always, is to do it right.

Chris O’Neal is Managing Partner at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia.