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Why Might Intermountain Have Chosen Cerner Over Epic?

An anonymous person on HIStalk gave some really interesting insights into Intermountain’s decision to go with Cerner instead of Epic.

Re: Intermountain. The short-term choice (three or so years) would have been Epic, but we went with Cerner because of Epic’s dated technology, Cerner’s openness, and the feeling that we would be more of a partner than a customer with Cerner. The partnership is more than words. We’re working closely with Cerner and their horde of sharp, dedicated people on the implementation. We have some pieces they don’t and those are being built into the Cerner system, while some of our own development efforts have been redirected since Cerner already has that functionality. The first rollout is scheduled for December and I think it will go well due to the way the teams are working together. Unverified.

This is the best analysis of Intermountain’s decision to go with Cerner that I’ve seen. As in every billion dollar procurement decision, it’s always got other nuances and pieces that go into the decision making process. However, the above analysis gives us a good place to start.

Let’s look at the main points that are made:

1. Is Epic technology more dated than Cerner?

2. Is Cerner more open than Epic?

3. Will Cerner be more of a partner than Epic would have been?

I’d love to see Judy’s (Epic CEO’s) comments on all of these. I’m sure she’d have a lot to say about each of them. For example, you may remember that Judy described Epic as the most open system she knows. Ask someone who wants to get Epic certified if they’re open. Ask a health IT vendor that wants to work together if Epic is open. Ask even some of their smaller customers who want to do things with Epic if Epic is open. They’d all likely disagree that Epic is the most open system.

I’d love to hear people’s thoughts on each of these three points. I think it will make for a really lively discussion that will help us get closer to understanding the reality of these assertions.

However, reality aside, I can tell you that the public image of Epic vs Cerner certainly confirms all three of these points. Whether Intermountain indeed used these points as part of their decision process or not, I don’t know. What I do know is that it wouldn’t surprise me at all if they did think this way since there are many in the market that believe and share all of the above three impressions.

July 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Georgia EMR Disaster: Was IT Department Responsible?

A few weeks ago, heads began to roll at Georgia’s Athens Regional Health System when its $31 million Cerner rollout began to fall apart. After clinicians complained that a rushed rollout process was generating a host of medication errors and other mistakes, President and CEO James Thaw resigned, and less than a week later, SVP and CIO Gretchen Tegethoff left as well.

Since then, however, the political landscape there has changed, with the facility’s chief medical officer, as well as Cerner executives, contending that the disaster was due to mistakes by the health systems IT team, according to HealthcareITNews. The Cerner execs, CMO and others are arguing that IT leaders made strategic decisions that should’ve been made by clinicians, the publication says.

A local paper, the Athens Banner Herald, notes that the Cerner rollout was done largely by the hospital’s IT team, and that few end-users were involved. That, at least, is what Cerner VP Michael Robin told the paper.  And a different Cerner VP, Ben Himes, took another shot at the IT department, arguing that this implementation seems to have come out on the IT side of things, rather than stressing clinical involvement.

The bottom line seems to be that regardless of what actually happened, the clinicians at the hospital seem to of felt left out of the process, never good thing when we’re dealing with a tool that they’ll need to use everyday.  Regardless of what actually happened, it seems the hospital’s IT department didn’t do a good job of engaging clinicians and getting their feedback; under those circumstances, the likelihood of kicked up a fuss even if implementation was otherwise smooth.

On the other hand, I’m always a little skeptical when vendors point fingers at their customers and say it was their fault when things go wrong. OK, I realize that there may be some truth to their accusations, and that Cerner has a right to defend itself, but it’s hardly a good PR move to dump problems with the implementation completely in the customer’s lap.

The truth is, will probably never know exactly what happened with this EMR implementation. Considering the scale of the project, and the number of people involved, it’s inevitable that this will go down in a blaze of finger-pointing. But it never hurts to be reminded that EMR implementations which leads physicians feeling as though they’re on the sidelines are politically risky at best, and potentially disastrous at worst.

 

June 18, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Cerner EHR Physician Training Video

I posted the following video on EHR videos, but I thought that many readers of this site would find it really interesting as well. The video has a bunch of physicians talking about their training for the Cerner EHR. I’m sure many of you have heard doctors just like the ones in the video before. Here’s a little background on the EHR implementation:

Via Christi is part of Ascension Health, and it’s the largest health system in Kansas. It has about a dozen hospitals across the state, several more clinics and senior centers. They had 15 different EHR systems they turned off when they switched to Cerner’s EHR. The Kansas paper reported that the new EHR cost $85 million.

I love to listen to all the doctors talking and think “and what’s the rest of the story.” If you listen carefully you can see how many of them are very careful with their wording.

June 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital CEO Resigns Over Failed EHR Implementation

The social media world has grabbed on to a story at Athens Regional where it looks like the poorly done Cerner EHR implementation has “forced” the CEO to resign. Before I talk about the story, I’ve been amazed at how many tweets and retweets there have been for this story. It’s like the proverbial rubber neck we all get when we pass a car accident. I guess reading about a CEO resigning over a failed EHR implementation is must tweet HIT.

Getting back to the story, it seems like the real death nail in this hospital CEO’s coffin was when the doctors started dropping their privileges at the hospital. Here’s a quote from the story linked above:

“The Cerner implementation has driven some physicians to drop their active staff privileges at ARMC,” noted the letter. “This has placed an additional burden on the hospitalists, who are already overwhelmed. Other physicians are directing their patients to St. Mary’s (hospital) for outpatient studies, (emergency room) care, admissions and surgical procedures. … Efforts to rebuild the relationships with patients and physicians (needs) to begin immediately.”

The comments on the article are quite interesting with one doctor talking about how doctors were finally taking control and pointing out the harm these EHR systems are causing. Obviously, I think that’s a huge stretch. Uncooperative doctors can contribute to the harm an EHR can cause as much as the EHR software itself. Although there is a subset of doctors that feel like they need to start a revolution against EHR.

The reality is that the job of hospital CEO isn’t easy. That’s why they get paid millions of dollars (at least a lot of them). In fact, leadership in general is not easy. It’s a hard balance to know when you should trust your team and when you need to dig a little deeper and find out what’s really going on. Either way, this story should be a huge warning to hospital CEOs that they better have a deeper relationship with the hospital CIO.

I’m always surprised when a hospital still doesn’t have the hospital CIO as part of the executive team. Going forward, your EHR and other healthcare IT is going to be one of the biggest factors in the success of your organization. This story illustrates that really well.

I think we’d all agree that the number one thing you can do as a leader is make sure you hire and retain the very best employees. This story is a great example of why your EHR and how you implement it matters when it comes to getting and retaining the very best people. Plus, this is only going to become more important as technology continues to improve.

I obviously don’t know the particulars of this specific story. No doubt there are a few hundred views of what happened. Although considering the stories of what’s coming out, I’m guessing there is plenty of blame to go around. The hospital CEO was just the scapegoat for much larger issues.

Let this be a warning to hospital leadership. Make sure you’re paying enough attention to healthcare IT. It’s now an integral part of what you do.

June 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The Best Thing For Epic Might Be to NOT Win the DoD Contract

For those not familiar with the Department of Defence (DoD) EHR contract that’s being bid on right now, check out our post about the $11 billion EHR contract. Yes, you’re reading that right. That’s $11 billion with a B. I believe that would be the largest single EHR contract ever (I believe Kaiser was $4 billion to start).

Needless to say, this is an enormous contract that will make some outside companies very rich. I can’t even imagine what $11 billion of EHR consultants and software would look like. That’s a lot of EHR jobs to go around, but I digress.

Most people in the industry seem to believe that Epic is the front runner in the race. Considering the number of large deals that Epic has won, Epic winning the DoD EHR contract would be a safe bet. Although, I wonder if the best thing for Epic would be for them to not win the DoD contract.

Sure, Epic would take a short term PR hit if someone else like Cerner wins the DoD contract. You can already predict the press headlines talking about the fall from power as Epic loses to Cerner (similar to when Cerner won the Intermountain deal over Epic). That would have some damage to Epic’s reputation, but not really. It’s not like any other hospital in the US thinks that their contract would be anything like the DoD EHR contract. In fact, many of the hospitals purchasing Epic EHR will be grateful that Epic resources aren’t being tied up on a new $11 billion contract while their “small” $100 million EHR project languishes.

Indeed, the best thing for Epic might be for it to NOT win the DoD EHR contract. Let’s remember that Epic has a really good history of successful EHR implementations. Sure, there are a few examples where the Epic implementation hasn’t gone so well. However, I think the general view of the industry is that Epic implementations generally go well. In fact, there are stories of Epic contracts so stringent that when an Epic implementation starts to go bad, Epic comes in and takes over to make sure that the implementation goes well.

Long story short, Epic has the best reputation of any hospital EHR vendor when it comes to successful EHR implementations (especially large ones). Epic winning the DoD EHR contract could do a lot to tarnish that reputation.

One might argue that if Epic’s successful with the $11 billion DoD EHR contract, that it will be a boon to their current reputation. That’s fair, but the DoD EHR implementation would be unlike most other EHR implementations. First, the DoD doesn’t have a sterling reputation for successful healthcare software projects. That will likely become an issue for anyone who wins the contract. Second, we’re talking about a government entity with layers of red tape and bureaucracy. A small company like Epic (small in government contractor terms) isn’t going to carry the same weight as they usually do in their other hospital EHR implementations. Epic, the control company, won’t be able to control the DoD EHR project the same way they usually do.

One could use the same argument I used above about why even if Epic gets the DoD contract and fails, it won’t tarnish their reputation since hospitals realize that the DoD is unique. However, the difference between losing a bid and a failed $11 billion project is very different. The failed DoD EHR bid will be covered once and then generally forgotten. A failed $11 billion contract can carry on for years as timelines are delayed, budget overruns are reported, discontent leaks out, he said-she said occurs, and the media churns and speculates on what’s happening with the DoD EHR project.

We all think that winning an $11 billion contract would be great. Indeed, that’s a lot of money and would be an enormous win worth celebrating. The only question is how long will the celebration continue? If I’m Epic, I wouldn’t be too sad if I didn’t win the contract. In the long term, it might be for the best.

June 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Meditech – The Never Talked About EHR Power

I was cruising through Twitter today and saw the following tweet about Meditech EHR.

Don’t you love Twitter? Meditech can buy this kind of marketing. Hopefully for Meditech’s sake, Dr. Parker is right and that Meditech’s latest version is heading in the right direction.

The hospital EHR market is so interesting. Everyone looks at it as a two horse race with Epic and Cerner. Both of those EHR companies have done phenomenally well and so they should get a lot of coverage. However, people always seem to forget about Meditech. It’s odd to me because they still have a really large footprint in healthcare. You’d think they’d get more coverage, even if the coverage was pointing out the wrong steps they’re taking. Instead, I’ve seen very little coverage of them at all.

I took a quick look at Meditech jobs on the Healthcare IT Central job board. There are still a lot of them listed. That’s usually a good sign for a company.

Why doesn’t Meditech get any coverage lately? Are they a sleeping giant that could finally wake up? I’d love to hear your thoughts.

May 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Cerner Agrees To Pay $106M Over Allegedly Defective Software

After years of back and forth, Cerner has settled a dispute with a North Dakota hospital claiming that Cerner’s financial software was defective and didn’t deliver expected business benefits.

Back in April 2012, Trinity Health told the vendor that it was transitioning away from Cerner’s patient accounting software solution and certain IT services provided by Cerner. At the time, it alleged that the patient accounting solution didn’t work right.  Of course, Cerner disputed the allegations, according to its 10-K yearly report.

The two players began arbitration in December 2013, a move which allowed Cerner to collect some payments due from the hospital.  At the outset, Cerner was predicting liability you of up to $4 million, while Trinity anticipated damages totaling $240 million.

Ultimately, the two agreed upon a settlement under which Cerner would pay Trinity $106 million. Interestingly, Trinity is continuing as a client of Cerner for its clinical solutions, something you might not expect under the circumstances.

This is a particularly unusual outcome for a vendor/hospital dispute, because most vendor contracts contain clauses to eliminate “consequential damages,” which limit hospital’s ability to take legal action, notes Trinity attorney Michael Dagley. That being said, there are areas under state and common law provisions of consumer fraud statutes, under which manufacturers cannot misrepresent product capabilities and benefits.

Knowing how hard it is for a hospital to sue a vendor of IT services, it makes you wonder whether the growing number of hospitals dumping their current EMR are doing so because they’re not getting what they want but can’t sue to get their money back.  While it may be heinously expensive, buying a new EMR and installing it is certainly faster than going through years of court proceedings and then having to buy another EMR nonetheless.

March 12, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Large Health Systems May Miss Stage 2 Deadline

Usually, it’s the small institutions that are having fits when an IT program deadline is approaching. This time around, it’s the big boys that are struggling.

Intermountain Healthcare has announced that the organization will probably not attest to Stage 2 of the Meaningful Use program this year over concerns about patient safety, according to iHealthBeat

In an interview with HealthLeaders Media, CIO Marc Probst said that with the organization transitioning from its own EMR to EMR software from Cerner, all the software will not be running at all of the locations by the end of this year. This isn’t surprising after the relatively recent announcement that Intermountain would be switching to Cerner.

It’s not clear what it says about the success of the Meaningful Use Stage 2 program, other than that Intermountain has other priorities, but it does make you wonder what other large health systems will take a similar posture.

After all, ONC Chief Medical Officer Jacob Rieder (who also spoke with HealthLeaders) said that other large institutions are reporting similar situations. As amazing as it sounds considering the money involved, I won’t be surprised if we see more institutions following similar paths. There are a decent number of hospitals that haven’t even selected an EHR software.

According to Reider, it will be easier for small providers to meet Stage 2 requirements, given that they generally don’t have to plan as far into the future. But when it comes to large health systems, it seems that achieving this year’s Meaningful Use goal is a bridge too far.

March 4, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Hospitals Don’t Prepare For Full Costs of EMR Installs

A new study published in Medical News Today concludes that UK hospitals aren’t always taking into account the full costs of implementing new EMRs, and as a result, are not receiving the full benefits of these systems.

The study, which was published in the Journal of the American Medical Informatics Association, evaluated the implementation of three EMRs — iSOFT’s Lorenzo Regional Care, Cerner’s Millenium and CSE’s RIO — across 12 diverse healthcare organizations in three regions of the UK and at different stages of implementing the systems.

Researchers also conducted 41 semi structured interviews with 36 hospital staff, members of the respective implementation teams, and those spearheading the implementation at a national level.

The research team found four overarching cost categories associated with implementing EMR system: infrastructure, personnel, facilities and other (such as training materials).

As might be expected, the hospitals involved spent their EMR budget in significantly different ways. For example some hospitals spend big on testing the software, while others spent large sums training clinicians and administrative staff to use the new system.

The hospitals also made significantly different decisions when it came to hiring new staff to cover for those who were in training. One hospital spent over $1.1 million to provide covering staff, while another spent no money at all to cover from for staff and training.

When all was said and done, hospitals were most likely to cut back on training and implementation costs. Meanwhile, hospitals were also likely to under budget for factors such as the need to back fill staff to the lost productivity, and the need to test the system due to inadequate vendor testing.

February 17, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

2013 Hospital EHR and Health IT Trends

There are a number of amazing milestones and trends happening with EHR and Healthcare IT. I think as we look back on 2013, we’ll remember it for a number of important changes that impact us for many years to come. Here are a few of the top trends and milestones that I’ll remember in 2013.

Epic and Cerner Separate Themselves – This has certainly been happening for a couple of years, but 2013 is the year I’ll remember that everyone agreed that for big hospitals it’s a two horse race between Cerner and Epic. There’s still an amazing battle brewing for the small hospital with no clear winner yet. However, in the large hospital race the battle between Cerner and Epic is on. Epic had been winning most of the deals, but Cerner just gave them a big left hook when Intermountain chose Cerner.

I expect we’re living in an Epic and Cerner world until at least a few years post meaningful use. The job listings on Healthcare IT Central illustrate Cerner and Epic dominance as well.

Near Universal EHR Adoption in Hospitals – I can’t find the latest EHR adoption (meaningful use) numbers from ONC, but the last ones I saw were in the high 80′s. That basically leaves a number of small rural hospitals that likely don’t have much tech infrastructure at all, let alone an EHR. Every major hospital institution now has an EHR. I guess we can now stop talking about hospital EHR adoption and start talking about hospital EHR use?

The Cracks in the Healthcare Interoperability Damn Appear – Interoperability has always been a hard nut to crack in healthcare. Everyone knew it was the right thing to do, but there were some real systemic reasons organizations didn’t go that direction. Not to mention, there was little financial motivation to do it (and often financial disincentive to do it).

With that background, I think in 2013 we’ve started to see the cracks in the damn that was holding up interoperability. They are still just cracks, but once water starts seeping through the crack the whole structure of the damn will break and the water will start flowing freely. Watch for the same with interoperability. Some of this year’s cracks were started with the announcement of CommonWell. I think in response to being left out of CommonWell, Epic has chosen to start being more interoperable as well.

Skinny Data Happens – I was first introduced to the concept of skinny data vs big data at HIMSS 2013 by Encore Health Resources. While I’m not sure if the skinny data branding will stick, the concept of doing a data project with a slice of data that has meaningful (excuse the use of the word) outcomes is the trend in data analytics and it’s going to dominate the conversations going forward.

As I posted on EMR and EHR, Big Data is Like Teenage Sex, but skinny data is very different. Skinny data is about doing something valuable with the data. Sadly, not enough people are doing skinny data, but they all will in 2014.

Hospitals Ignore Consumer Health Devices – Consumer health devices are popping up everywhere in healthcare. We’re quickly reaching the point that consumers can monitor all of their vital information at near hospital grade quality using their smartphone and sometimes an external device. This is a real revolution in medical devices. Many are still making their way through FDA approval, but some have passed and are starting to work on traction.

With all of this innovation, hospitals seemed to have mostly ignored what’s happening. Sure, the larger ones have a few pilot projects going. However, most hospitals have no idea what’s about to hit them upside the head. Gone will be the days of patients going to the hospital to be “monitored.” I don’t think most hospitals are ready for this shift.

December 31, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.