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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.

Value Based Care Hurting Most Vulnerable Hospitals

Posted on March 25, 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.

In an article by the Washington Examiner, they highlight an interesting impact of the shift to value based reimbursement on hospitals:

Safety-net hospitals are getting hit by Obamacare’s push to penalize poor quality, the latest evidence of problems with the law’s effort to improve quality of care.

A new study from Harvard Medical School found that safety-net hospitals that treat many low-income or uninsured individuals are being penalized more for hospital readmission rates than other hospitals.

If a hospital readmits too many patients 30 days after they are discharged after being treated for a certain condition, that hospital gets penalized. A hospital could receive up to a 3 percent reduction in its Medicare annual patient payments.

The policy, which started in 2011, a year after Obamacare was passed, is intended to address a quality issue at hospitals. It is part of a larger shift in Obamacare to transition Medicare payments away from traditional fees for service toward a new model that rewards quality care.

We saw something similar to this happen during meaningful use as well. The most vulnerable hospitals couldn’t get the EHR incentive money because the incentive money wasn’t enough to cover the entire costs of the EHR. So, they just went without. In fact, an argument could be made that a large portion of the meaningful use EHR incentive money was paid to hospitals that were already on the path to EHR, but that’s a topic for another day.

When it comes to value based reimbursement it takes the right investment in technology and processes to be successful. I know a lot of hospitals that are just trying to keep their doors open. Where does that leave them time to think about these new complex government regulations? No doubt this shift to value based reimbursement is going to cause a lot of them to close their doors or be merged into the larger hospital systems. In fact, the later has been happening for a while and will continue to accelerate.

The article above does suggest a possible solution:

One alternative would have a hospital be measured by how its readmission rate improves rather than whether it meets a national average.

“Hospitals could be rewarded based on improvements off what their prior performance has been,” Barnett said.

Another alternative is for a hospital to become an accountable care organization. The concept gives a hospital a spending growth target that it has to meet for its Medicare patients.

I like the idea of benchmarking, but that can get really messy really quickly. The more I learn about value based reimbursement the more I worry that we’re just making things more complex without actually solving healthcare’s core problems.

KLAS: Epic Losing Ground To Cerner

Posted on September 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.

At this point in the EMR buying cycle, one would figure that the market for new hospital EMR purchases is pretty saturated, especially among larger hospitals with the capital to invest in big health IT projects. But according to a recent blog entry from KLAS, that’s not exactly the case.

In his blog item, KLAS researcher Colin Buckley notes that his firm has been watching clinical IT vendor wins and losses at 200+ bed hospitals for 10 years.  During that period — and especially post- Meaningful Use — KLAS has seen a growing number of new hospital EMR contracts.

By this point, after lots of EMR buying, and some switching out technology for second and third-choice EMRs, one might think that over-200-bed hospitals had settled on a platform that they could live with through Meaningful  Use Stage 3. Actually, not quite, Buckley says.

In fact, KLAS data shows that there are more hospitals running legacy EMRs, homegrown EMRs or no EMR at all than those who have bought a currently-marketed solution sometime in the past four years. And it’s likely these hospitals will be choosing a new EMR from the current vendor marketplace within the new few years, KLAS projects.

As sales increase in the 200+ bed hospital segment, market forces are shifting to favor new vendors. What’s particularly noteworthy about this is that the research firm has seen the ratio of Epic-to-Cerner wins shrink from 5-to-1 in 2010 to 2-to-1 in 2012.

According to KLAS, the hospitals that are likely to be out buying new EMRs look different than those which have already bought and implemented the EMR they’ll use for the next several years. “They are smaller and more cost conscious than the large hospital IDNs that have given Epic a lion’s share of wins year after year,” Buckley writes.

With Cerner and Epic busy eating each other’s lunch, Allscripts, MEDITECH, McKesson and Siemens are moving ahead as quickly as possible to roll out integrated ancillary and ambulatory solutions, Buckley notes. In other words, the competition for both ambulatory and hospital EMRs is far from played out.

Despite all of this activity, we are clearly in a late stage of the EMR market as a whole, or as my colleague John Lynn puts it, “the Golden Age of EHR adoption is over.” But if KLAS is right, there’s still some very healthy bucks to be made selling to laggard mid-sized hospitals. Let’s see if vendors used to serving hospital giants can adapt in time.

AHA, AMA Seek More Flexible Meaningful Use Requirements

Posted on July 30, 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.

The American Hospital Association and the American Medical Association have sent a joint letter to HHS Secretary Kathleen Sebelius asking for more flexibility in the requirements for the Meaningful Use program, iHealthBeat reports.

The two trade groups, which called the program’s requirements “overly burdensome,” argue that as the current Meaningful Use program is structured, it’s too hard for some providers to keep up. “[W]e believe that the best way to move the program forward and ensure that no providers, particularly small and rural ones, are left behind is to realign the meaningful use program’s current requirements to ensure a safe, orderly transition to Stage 2,” the letter adds.

The letter makes four recommendations to improve the Meaningful Use program for providers, iHealthBeat notes:

* Let providers meet Stage 1 requirements using either a 2011- or 2014-certified EMR

* Set up a 90-day reporting period for the first year of each new stage of the program, applicable to all providers;

* Give providers increased flexibility to meet Stage 2 Meaningful Use requirements

* Extend each stage of the Meaningful Use  program to a minimum term of three years for all providers

The AHA submitted also submitted testimony to the Senate Finance Committee last week asking legislators to give providers more flexibility within the Meaningful Use program.

As things stand, unless current requirements for electronic clinical quality measures are changed, “clinicians [will be] spending extensive amounts of time working for the EHRs” rather than having the EMRs work for them, the trade group suggested.

As part of its testimony, the AHA presented case studies drawn from four separate hospitals. Based on the issues arising at these hospitals, the group recommended several changes to MU, including using fewer, better-tested electronic quality reporting measures, starting with Stage 2, and making EMRs and electronic clinical quality measure reporting tools more flexible to align data capture with the nuances of workflow.

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

Survey: Healthcare CIOs Average $200K In Annual Base Salary

Posted on April 9, 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.

While numbers varied widely depending on organizational factors, healthcare CIOs earned an average base salary of $208,417 in 2012, according to a recent survey conducted by CHIME.

The survey, which drew responses from small, medium-sized, large and rural facilities, drew responses from 263 CIOs from late December 2012 and early January 2013.

Some key findings from the survey included the following:

Multi-hospital, academic medical center execs make more  The average base salary reported for multi-hospital system execs was $254,054. and the academic medical center CIOs reported an average $243,229 base salary.

Smaller-hospital CIOs make much less  Top IT execs at the smallest hospitals, CAHs with 25 beds or less, got an average base salary of $125,573. Execs at hospitals with fewer than 200 beds reported an average base salary of $150,956, or about 28 percent than the overall average, notes iHealthBeat.

Standalone execs make less  CIOs with stand-alone community hospitals also responded lower income than the average, at $178,786, roughly 14 percent less than the overall average.

*  Titles matter, a lot  Hospital leaders with the title of CIO had average base salaries of $199,890, about four percent less than the overall survey average, but when they had additional titles salaries went up starkly. CIOs who were also titled vice president had an average salary of $206,788, while those with CIO and executive vice president had an average salary of $310,326, or almost 49 percent over average.  Meanwhile directors of IS or IT averaged $128,193, or about 38 percent less than the survey average.

Reporting relationships count As iHealthBeat reports, salaries varied depending on who the CIO reports to in the organization.  The 44 percent of respondents who report to the CEO earned ann average of $217,170, or about 4 percent more than average.  Meanwhile, those reporting to the CFO earned an average base salary of $175,263, or 16 percent less than the average of salaries reported.

Few and small raises reported  Despite the huge amount on health IT execs’ plates, most survey respondents reported minimal  pay raises, with almost 75 percent saying that their base salaries increased by less than 5 percent between 2011 and 2012.

So, readers, how do these numbers look to you?  Do they reflect the realities of your institutions? And how about those low raises — think hospitals are risking losing critical talent by holding that line?

Real-Time Responses To EMR Training

Posted on February 28, 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.

Teaching hospital staffers and clinicians to use your EMR is a hard enough job. Figurng out just what they didn’t learn during training is even harder. But here’s a trick some hospital administrators and IT leaders are using to do just that.

A report in the HealthTechZone blog notes that at St. Joseph Hospital in Chicago, they’ve already seen some success with a technology that allows audiences to respond to quizzes embedded in EMR training materials.

The hospital’s training sessions use a polling software application called TurningPoint which allows audience members to respond to questions in real time, using either their smart phones or “ResponseCard” keypads. The technology also allows presenters to bring in audience members not in the room at presentation time and collect their responses to polls remotely.

At St. Joseph, administrators use this technology to structure their EMR training sessions more effectively and focus in on areas where the audience seems not to have understood what was presented.  It’s as simple as sending the training group on a break, reviewing the quiz and reorganizing PowerPoint slides to re-emphasize any points that the audience missed.

But the response technology’s use doesn’t end there, the blog reports. Once the formal training is over, administrators hand audience polling results to the IT team. IT administrators then use the data to address employee concerns as they proceed with the EMR rollout.

I think this is a great approach, not only for training but for gauging employee (and clinician) support for the EMR rollout, gathering input on the effectiveness of the EMR in users’ daily work lives, and generally fostering EMR acceptance by having a finger on the pulse of user sentiment.  Readers, have you tried anything like this?

The Dawn Of “Compliance As A Service”?

Posted on October 5, 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 few days ago, I posted a quick report on our EMRandHIPAA.com sister site discussing Verizon’s plans to offer a HIPAA-compliant cloud service.

Verizon, which has beefed up on security services over the past few years, seems to see its role as being compliance vendor rather than just a mere business associate.  The carrier notes that not only does it offer super-secure data centers, it has trained staffers on HIPAA-specific data handling issues.

But Verizon obviously isn’t the only cloud vendor out there capable of offering HIPAA-compliant services. Could this be the dawn of CaaS (compliance as a service) for healthcare? (Others industries, like banking, are already well into this approach.)

According to reader Scott Gardner, who commented on the story, this concept has legs. “I’ve been pitching [Compliance As A Service] to cloud-based persistency vendors targeting mobility for some time,” writes Gardner, whose company Inyago focuses on private practice IT services via MacPractice. “Offering this service makes perfect sense, especially in private practice healthcare. And you get interoperability (core #14) right out of the box for all users on the platform.”

The burning question here, I suppose, is whether CIOs feel safe trusting outsiders with clinical data flow. Right now the answer seems to be “no.” As my colleague John noted in a related blog post, at present even those providers who are cloud users are more prone to access it for “commodity” services such as e-mail, file storage, videoconferencing and online learning, according to a CDW survey.

With providers needing interoperability under Meaningful Use Stage 2, the landscape may change, however. Whether or not they’re terribly comfortable with Verizon and its rivals, CIOs might find it easier to delegate compliance than cope with the difficulties of build-your-own-interoperability schemes. So perhaps CaaS really does have a chance at achieving rapid uptake — unless someone invents the insta-install HIE!

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?

What Won’t Happen In #HIT By September 2013

Posted on September 7, 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.

As part of the upcoming National Health IT Week (#NHITWeek), which takes place September 10 through 14th) my august colleague John has written up a list of ways in #HIT is likely to make a difference over the next 12 months.  (He makes some great guesses; definitely give the post a look.)

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?”  Here’s some of my predictions:

* EMR-to-EMR interoperability:  Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

High penetration by HIEs:  With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

Major uptick in open-source HIT  use:  Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

Epic controls the hospital EMR world for good:  Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak.  But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring:  Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs.  I just think we’re going to remain stuck with some of these legacy issues for some time to come.