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Should Hospital Associations Choose EMRs?

Posted on October 10, 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.

Today I read a press release trumpeting the new relationship between the Texas Hospital Association and Enterasys Networks, which is now the THA’s preferred provider for wired and wireless network infrastructure products.

When I read this I found myself thinking “wow, is it really that easy?” Will hospitals rely on intermediaries like the THA to do the due diligence and sort out what sort of networking gear they should buy?

To me, this is an intriguing concept which could easily and logically extend to EMRs. After all, state hospital associations could do an analysis of an EMR’s technical strength, usability, interoperability and features as well as a  health system or hospital could.

It would certainly upend the industry if hospital associations routinely got down and dirty with EMRs, went through a selection process and put their “recommended” stamp on a small handful of systems.

If nothing else, it would be a shock to vendors, who would have to create new channel relationships with the associations, quickly and well. Marketing to associations wouldn’t superceded marketing to individual hospitals completely, but it would add a new layer of effort.

It would also give some attention to lesser-known EMR vendors. I’d argue that in an honest process, it’s unlikely that all — or even most — of the hospital associations would only choose as “winners” the enterprise EMRs that dominate the market today.  This is not to say that giants like Epic and Cerner would never be selected; it’s just that as I imagine it, a thorough hospital association selection process would identify some underdogs that deserve hospitals’ business.

The truth is, though, that most hospital associations wouldn’t want to go down the road of officially putting their stamp of approval on a small collection of EMRs. The task is enormous, the political costs high if members don’t agree with their choices, and the downside is considerable if a recommended vendor completely flames out in some way.

No,  it seems to me that while the THA has put its credibility on the line for Enterasys, I don’t see it (or its peers in other states) sticking an oar in the EMR selection business. There’s just too much at stake. They’ll spend their last penny fighting regulatory battles — particularly as Meaningful Use steams along — but hospital trade groups are not going to become the EMR Fairy.

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 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.

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?

Impossible to Say “Wrong EHR”

Posted on December 19, 2012 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.

It seems that the CIO’s are defending the choice of EPIC because it is politically impossible to say they made a wrong choice after so many resources, money and time have been expended.

The above statement is incredibly scary for me to consider. In reality, it’s the opposite of the oft quoted statement, “no one gets fired if you choose IBM.” In healthcare I’ve often heard people say a hospital CIO doesn’t get fired if he chooses Epic.

We’ve all heard about Epic’s tactics for selecting which hospitals can use their EHR. They are highly selective and say no to a lot of hospitals that they don’t think are the right fit for Epic (whatever fit that might be). I even heard one rumor on HIStalk that when an Epic install goes downhill, Epic will offer to pull out and refund all of the money or require that the hospital pay them a lot of money to have Epic send in a recovery team to try and get the Epic EHR install back on track.

When a hospital has invested hundreds of millions and even billions of dollars on a specific EHR software, things can get messy really fast. Imagine you’re a hospital CIO (which many of you that read this site are) that had just spent hundreds of millions of dollars on Epic. Would you be able to go back to the CEO or CFO and say that it was the wrong choice. That’s not an easy discussion to have and I expect very few hospital CIO’s have the gumption to have that conversation.

Although, let’s not put all of this on Epic. Certainly some of the same dynamics are exhibited by all hospital EHR purchases regardless of EHR vendor.

Besides the large contracts that are signed with EHR vendors, the other major reason hospital CIO’s can’t say that they made a mistake in their EHR selection is because of the lack of EHR data liquidity. Once you start entering your data into an EHR, getting it out is like climbing Mount Everest. Only a few people know how to do it, most aren’t successful, and its guaranteed to cost you a lot of money. If EHR vendors would free up the EHR data, it still wouldn’t be an easy decision, but it would help.

Hospital EHR Incentive Makes the Rich Richer

Posted on July 10, 2012 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.

A few months back, Anne Zieger did a post discussing AHA’s comments that the Meaningful Use schedule is too ambitious that started me thinking about what’s really happening with the EHR incentive money.

Think about the hospitals that were best positioned to get access to the EHR incentive money. In most cases, they were the hospitals that were rich enough to implement IT and EHR well before the EHR incentive money even existed. I’d love to see a survey of hospitals that started their EHR implementation after the announcement of the EHR incentive money. Yes, I’m being generous. I’m not even taking into account the arduous EHR selection process that can often go on for years. If you added in that time frame, I wouldn’t be surprised if no hospitals selected and implemented an EHR post EHR incentive money.

Remember that most enterprise software projects in a hospital take multiple years to accomplish. Most hospital EHR implementations are an enterprise software project on steroids. That means that those hospitals that were already well down the path of EHR adoption are those that got paid the EHR incentive money. Those hospitals that could really use the EHR incentive money are still sitting there trying to figure out how they’re going to implement an EHR.

I’m sure there are plenty of cases where the EHR incentive money hastened EHR implementations that would have taken much longer. I know a number of hospitals that had EHR somewhere on their list of IT projects. No doubt the EHR incentive money bumped up the priority of that project.

I can’t help but see the irony of Obama having an EHR incentive program that makes the rich hospitals richer.