Cerner | Hospital EMR and EHR

ONC Proposes New EMR Vendor Fee

It looks like federal budget balancing fervor could soon have an impact on EMR vendors (See also this post on EHR Incentive and Sequestration). As part of President Obama’s current budget proposal, the ONC is suggesting that health IT vendors pay about $1 million in fees to help pay for its certification and standards work, reports Modern Healthcare. Collection of the fee, which would probably begin late in the fiscal year, would be collected by ONC-Authorized Certification Bodies.

The proposal is part of the ONC’s section of the overall budget proposal released this week by the Obama Administration. The president’s budget is already causing a stir in healthcare circles outside of IT, as it calls for $5.6 billion in Medicare payment cuts for fiscal 2014.

So what has caused the ONC to look for fresh revenue? One key reason is that ONC’s $2 billion appropriation from ARRA is scheduled to expire at the end of fiscal 2013, and the agency needs new funds to stay on its feet.

By its logic, the improved testing and certification programs will help vendors save time and money, which justifies their kicking in some money to support the process, Modern Healthcare says.

Not only would the funds gear up the certification program, it would also help maintain ONC’s Certified Health IT product list, as well as its development work around standards for interoperability and policy docs related to HIT certification, the magazine reports.

Without a doubt, the proposed fees will make vendors unhappy, but as I see it they’re just not large enough to justify a major uprising by the health IT community. The only real issue I see is whether the fees are going to be proportionate to the size of the vendor; if I were a small ambulatory player I’d be quite upset if I paid the same fee as Epic or Cerner.

Otherwise, this fee seems like a relatively small issue, particularly if ONC does a good job of using the funds to improve the certification program. Let’s hope it works out that way.

CommonWell Alliance Goals Challenged By ONC

As virtually everyone in health IT knows, HIMSS saw the dawning of a new EMR vendor alliance which proposes to make health data exchange simpler. The group, the CommonWell Alliance, includes McKesson, Cerner, Allscripts, Greenway and athenahealth, plus McKesson’s connectivity business RelayHealth.

Now that the PR fairy dust has settled and we’re talking serious business, it’s a good time to consider exactly what these vendors hope to accomplish, as we’re talking about enough vendor muscle to have a serious impact on the way health data is shared.

This week, ONC released a report doing just that, according to a piece in Government Health IT. At a meeting of the Health IT Policy Committee on April 3, National Coordinator for Health Information Technology Farzad Mostashari, MD and other committee members discussed the report, which raised some hard questions about the Alliance.

According to Government Health IT, the report outlined the following as CommonWell’s chief goals:

Enabling providers to unambiguously identify patients – but not with a national patient identifier;
Providing a way to match patients with their healthcare records as they transition through care facilities;
Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
Enabling patients to manage consent and authorization;
Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.

Unlike most standards-setting efforts, members of the group are going to have to pay if they want to participate, a nice little detail that wasn’t made clear when CommonWell was announced.

Though it will be at least a year before CommonWell pilots its approach, members of the Committee are quite appropriately wondering now about the impact of such an effort.

Dr. Mostashari argued that the key question is whether the service will work as an optional overlay across a regional exchange, or whether it requires exclusive participation. Other committee members agreed.

The bottom line for committee members, Government Health IT reports, is that they’re willing to take a wait-and-see approach. As for us out here in the peanut gallery, I believe we should challenge the heck out of this thing.

Members of the Health IT Policy Committee are well advised to wonder whether this coming together of powerful HIT vendors could undermine broader efforts to foster interoperability. There’s a lot to look into here, even if the allmighty Epic never joins.

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April 8, 2013 I Written By Anne Zieger

Filed Under: Health Information Exchange HIE Hospital EHR Hospital EHR Company Hospital EHR Vendor Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital EMR Company Hospital EMR Vendor Hospital Healthcare IT

Tags:Allscripts athenahealth Cerner CommonWell Alliance Epic Greenway McKesson

Best Of Breed Systems Lead In Battle For Meaningful Use Dollars

This week, Modern Healthcare published a very interesting analysis of ONC and CMS data on which vendors were used for Meaningful Use attestation. The results suggest that the battle for market dominance may be closer than it looks when it comes to producing results that count. Perhaps more importantly, the data suggests that best-of-breed systems may have a stronger foothold than unified systems (see more below).

According to Modern Healthcare, four vendors stood out as leader in the complete inpatient EMR market:

* Epic Systems, with 370 hospitals customers, or 17.9 percent of 2,071 hospitals which have attested using one of the four

* Meditech, with 323 hospitals, or 15.6 percent

* CPSI, with 313 hospitals, or 15.1 percent

* Cerner Corp., with 208 hospitals, or 10 percent

All told, these top four players have sold 1,214 hospitals a complete inpatient EMR system. That’s represents 58.6 percent of all systems sold to hospitals that have gotten a Medicare incentive check using a complete inpatient EMR. The top 10 vendors swelling such systems, meanwhile, have sold them to 1,902 hospitals, owning almost 92 percent of this niche, Modern Healthcare notes.

It’s important to note, however, that best-of-breed implementations have won even more Meaningful Use dollars, the analysis suggests. In fact, 2,438 hospitals using modular inpatient EMRs have achieved Meaningful Use. According to Modern Healthcare research, three developers lead the modular inpatient EMRs hospitals have used for this purpose:

* Meditech, with 637 hospitals, or 26.1 percent

* Cerner, with 530 hospitals, or 21.7 percent

* HCA Information & Technology Services, with 274 hospitals, or 11.2 percent

Collectively these vendors account for 59.1 percent of modular inpatient EMR market, the analysis shows.

I thought it was quite noteworthy that a larger share of hospitals are using best-of-breed inpatient systems to achieve Meaningful Use than complete inpatient systems. It would be interesting to find out if interoperability was one of the reasons hospitals are making this choice — since we know that the big vendors are shaky on the concept at best.

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April 1, 2013 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems Meaningful Use

Tags:Cerner CMS CPSI Epic Systems HCA Information & Technology Services MEDITECH ONC

EMR Vendors Need To Get Their Act Together

For quite some time now, EMR vendors have gotten away with selling products that aren’t very usable and may even pose safety risks. But that’s the price enterprise EMR buyers have been willing to pay to jump in and automate. Very soon, though, vendors may be held to a higher standard, a new report from KLAS.

KLAS recently held a bake-off comparing Allscripts, Cerner, Epic, McKesson’s Paragon, Meditech 6 and Siemens’ Soarian EMRs head to head where it comes to usability and efficiency, SearchHealthIT reports. The study looked at how the products worked for individual users, and then looked at how they meet organizational quality of care demands.

Some of the EMRs – and I wish SearchHealthIT had told us which ones — took a full month for physicians to learn. In some cases, physicians who were willing to take that month ended up with a richer experience than those which were easy and quick to learn, while in other cases, the darned thing still wasn’t usable. Of course, those with long learning curves and unimpressive features suffered from low physician adoption, the publication notes.

This is all interesting enough, but what grabbed me about the story was a provider quote from an end user, supplied by KLAS:

“As suggested by the new 2014 certification standards, vendors should take more responsibility for both the usability and safety of their products. These responsibilities shouldn’t be the sole purview of healthcare organizations and providers like they have been until now.”

Could it be that providers have finally gotten to the point where they’re no longer going to put up with unusable products and bring the hammer down even on giants like the big-shouldered group listed above? After all, so far providers have swallowed hard and accepted a lot of ugly technology.

Maybe Meaningful Use demands are finally giving health organizations the backbone they need to stand up to Jabba the Hutt vendors?

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March 22, 2013 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital EHR Company Hospital EHR Consulting Hospital EHR Vendor Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital EMR Company Hospital EMR Vendor Hospital Healthcare IT Hospital IT Systems

Tags:Allscripts Cerner Epic KLAS McKesson MEDITECH Siemens Soarian

Epic Not Invited To CommonWell Interoperability Alliance

Well, well, well. Far from refusing to participate, it looks like Epic may have been caught off-guard when a group of EMR players announced at HIMSS that they’d formed an interoperability alliance, according to a story appearing in Forbes.

For those who haven’t heard, Cerner, McKesson, Allscripts, Greenway Medical Technologies and athenahealth announced this week that they were forming the CommonWell Health Alliance, a non-profit dedicated to promoting interoperability between their products. Epic was conspicuously absent from the list of participants.

At the announcement’s outset, commentators like yours truly assumed that Epic, in its imperial way, had refused to join the party. After all, McKesson CEO John Hammergren had told the press that “everyone in the industry” had been invited to take part in the club.

But no, apparently this isn’t the case. “No, we were not asked to join,” Carl Dvorak, COO of Epic told the business magazine’s Zina Moukheiber. “We found out about it when you guys did.” Perhaps Epic wouldn’t have joined anyway — Dvorak is more of a fan of existing interoperability standards — but leaving a $1.5 billion EMR company off of the eVite list is pretty conspicuous too.

In the article, by the way, Dvorak repeats Epic’s often-made claim that their product isn’t a closed platform, stating that one-third of Epic EMR transactions are with non-Epic systems. In fact, he says that Epic can already connect with Greenway, Cerner and Allscripts, as well as NextGen. I’m not sure everybody reading this will take that statement face value.

Invited or not, Dvorak doesn’t miss the chance to get off a shot at the CommonWell guys nonetheless. He argues, as I have, that CommonWell may be more of a PR play than a real forward movement for interoperabiility. “It’s a marketing opportunity [for vendors],” he told Forbes. “They create the perception of leaders in the space, where they’re followers.”

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March 7, 2013 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital EHR Vendor Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital EMR Company Hospital EMR Vendor Hospital Healthcare IT

Tags:Allscripts athenahealth Cerner CommonWell Health Alliance Epic Systems Greenway Medical Technologies McKesson

How Danish Leaders Are Choosing Their EMR

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?

What Would It Take To Get More Hospitals On VistA?

Recently, we shared the story of of a California community hospital that decided to bypass big vendors like Cerner and Epic and go for a VistA installation instead. While Oroville Hospital ended up spending $10 million on its VistA implementation, that turned out to be about half of what it would have spent on Cerner and its big-vendor cousins. Then, to boot, Oroville got a $5 million Meaningful Use payout.

Yes, without a doubt, Oroville had a different experience when it went with VistA than it would have if it hired on Epic and had armies of be-suited consultants descend onto its campus. Any open source project faces the risk that the fervor and volunteer labor that makes up the backbone of its ongoing development efforts.

But given how much flexibility hospitals get out of the deal, and how much they save, it seems to me that you’d still expect to see more VistA projects being mounted. What would it take? Here’s a few ideas:

* Get a CCHIT-certified VistA product out there: Right now, hospitals don’t have such a choice. The only reason Oroville got its instance certified was thanks to special help from World VistA.

* Have more happy talk stories on how VistA can really work appear in serious business publications like Forbes: Arguably, peer pressure is a major reason hospitals stick to a short list of popular solutions. More coverage of VistA successes in major pubs creates its own buzz which may encourage IT leaders to reconsider their existing plans.

* VistA consulting firms need to become more common: Right new there are a few firms, like Medsphere, that will walk hospitals through the VistA installation process. But what if, say, Accenture had a division devoted to VistA support?

There’s not a lot you can do if a hospital CEO is determined to buy Epic or Meditech or Cerner. But if they want to consider VistA, there’s a lot the industry could do to help.

Other EHR Options When Epic Denies You

I got the following email from the CIO of a hospital.

They’ve [Quadramed] got the whole ONC-ATCB certified EHR for Phase 1 MU (although the point in your post is valid about that certification being fairly general anymore). They are working on obtaining and integrating/interfacing ambulatory functionality for physician practices, but for hospitals they have some pretty good sized hospitals running their QCPR product. KLAS includes them in their evaluation of EHR vendors (along with the likes of Allscripts, Cerner, Epic, GE, McKesson, Meditech, and Siemens) although they clearly don’t have as many installed hospitals that most of that list has. They also need to develop some real patient portal type of functionality to stay certified for future MU Phases. Not a market leader, but they are a market player. In spirit of full disclosure, we are almost live with Quadramed product, and we will be using it as a full EHR for both inpatient and outpatient care settings. We could not afford the bigger vendor solutions, and Epic wouldn’t even talk with us because we are below their minimum size to qualify for their sales efforts….only vendor I’ve seen that has that luxury of flat out ignoring possible business. We didn’t like the inflexibility of the lower end EHR vendors, and Quadramed provided a lot of the flexibility of bigger vendors for the price of the smaller vendors.

I’d love to learn where other hospital CIOs turn when Epic won’t give them the time of day. Considering Epic’s hospital size requirements and who they will work with, this is more hospitals than not. I started a list of hospital EMR and EHR vendors that might help. Where do hospital CIOs go when Epic isn’t an option? Is there a Denied by Epic support group somewhere online where hospital CIOs can commiserate?

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January 18, 2013 I Written By John

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

Filed Under: Healthcare CIO Hospital CIO Hospital EHR Hospital EHR Company Hospital EHR Vendor Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital EMR Company Hospital EMR Vendor

Tags:Allscripts Cerner Epic GE McKesson MEDITECH ONC-ATCB QuadraMed Siemens

A Hospital Chooses VistA EMR Over The Giants

Here’s a story out of the pages of Forbes which should make open source advocates happy. In it, we hear the tale of a northern California hospital which decided to buck corporate trends and go with VistA rather than pay for a big-ticket EMR from a vendor giant.

Three years ago, at the outset of its EMR search, Oroville Hospital was going down the same path as most of peers. But the CEO wasn’t terribly happy with that path. While the 153-bed hospital had shortlisted giants like Cerner, McKesson and Meditech as possible candidates, chief executive Robert Wentz was worried about the sky-high cost, disruption and — as a smaller facility — lack of clout with vendors, Forbes reports.

Shunning conventional choices, Wentz decided to take a risk on VistA. Not only did he go with the less-conservative choice, he decided not to partner with companies like Medsphere that help hospitals integrate and develop VistA to meet their needs. Instead, he chose to work with independent VistA experts (a rogue crew with day jobs of their own) rather than be tied to a particular vendor.

To coordinate the project, Wentz worked with the non-profit WorldVistA and Vista Expertise Network, both of which embrace hundreds of programmers with VistA smarts. Wentz worked with programmers from the two groups, not only to build out the hospital’s EMR but also to develop additional add-ons such as an e-prescribing package. WorldVistA CIO helped Oroville get its package certified for Meaningful Use, which brought in $5 million.

Now, three years into the project, Oroville has spent about $10 million on its EMR, about one-half of what it expected to spend on the giant EMR-makers’ software.

Now, it’s worth bearing in mind that Wentz and his IT team had to be more flexible than they would have if an army of consultants from Cerner or Epic had run the show. (I love the part in the Forbes story where a programmer told Wentz he had to end the call so he could make a trip to Costco. Classic.) But Oroville seems to have reaped the benefits. I wonder if this story will lead to more VistA adoption…

Top 10 Hospital EHR Vendors By Installed Systems

I came across this list of Top 10 Hospital EHR vendors by installed systems on Dark Daily (a great resource, particularly if you’re into Labs). The data is a little dated, but I thought it would be interesting to consider the numbers in 2011 and how they might look different today. Here’s the list:

Vendor Name	Total Installations	Percent of Installations
• Meditech	1212	25.50%
• Cerner	606	12.80%
• McKesson	573	12.10%
• Epic Systems	413	8.70%
• Siemens Healthcare	397	8.40%
• CPSI	392	8.30%
• Healthcare Management Systems	347	7.30%
• Self-developed	273	5.80%
• Healthland	223	4.70%
• Eclipsys (Bought by Allscripts)	185	3.90%

This list was taken from the HIMSS Analytics database. I wish I had access so I could compare these numbers for 2012. The interesting thing is that I’m not sure the Hospital EHR vendor numbers would be all that much different. Epic is the media darling, but its focus is squarely on the large hospital systems so they often lag behind when it comes to total installations.

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December 21, 2012 I Written By John

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital EMR Vendor Hospital Healthcare IT

Tags:Allscripts Cerner CPSI Eclipsys Epic Systems Healthcare Management Systems Healthland HIMSS Analytics Hospital EHR McKesson MEDITECH Siemens Healthcare

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