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AHA urges agencies to speed up EMR choice expansion

Posted on June 23, 2014 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.

In a move that shouldn’t surprise anybody, the American Hospital Association is urging CMS and the ONC to hurry up and finalize new rules which would expand choice for certified EMRs.

The AHA letter argues that its members are on the verge of walking away from Meaningful Use. But if CMS and the ONC speed ahead with with the new proposed rules — which would offer more choice in specific meaningful use requirements they must meet this year — hospitals will be much better equipped to proceed.

Why the rush? Well, for one thing, the letter argues, time is of the essence for hospitals, which have to decide their meaningful use strategy for fiscal 2014. If they must make choices before the new rule is finalized, it could cause them “significant financial and operational harm,” the AHA contends.

Meanwhile, if the agencies don’t push these rules through quickly, “many providers are likely to conclude that they cannot meet meaningful use this year and abandon the program,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development, in a letter to CMS Administrator Marilyn Tavenner and National Coordinator Karen DeSalvo, MD.

The letter also takes on other issues. It asks that CMS and ONC clarify the rules implementation, offer more flexibility in the reporting of clinical quality measures, shorten the MU reporting period for 2015 in analyze lessons learned from Stage 2 before finalizing Stage 3’s start date, according to HealthcareITNews.

The AHA’s letter comes at a challenging time for the meaningful use program generally, which has of late attracted broader attention than it has in the past.

Not only are industry groups pressuring ONC, legislators are too. For example, at a recent health IT conference, U.S. Rep Tom Price, MD, R-GA, argued that meaningful use is “maybe not even doing what needs to be done as it relates to patients and physicians.”

In his remarks, Price argued that meaningful use could be improved by keeping the patient front and center, making sure patients know they own their health data and establishing an interoperability standard.  But he suggests that because the MU program roadmap was laid out in the HITECH Act, it’s not as fluid as it should be and doesn’t accommodate such concerns.

The reality, however, is that there is no simple way to get interoperability; right now, we’re lucky if individual EMRs meet providers’ needs.  Despite the demands from other stakeholders, health IT vendors still have a lot more to gain by creating islands rather than interoperable products.

Purging EHR Data

Posted on April 4, 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 13 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.

Let’s talk about the always controversial and intriguing topic of purging EHR data. It’s something that’s no doubt talked about in every healthcare organization, but I honestly see very few people talking about it. So, let me get the discussion started.

I find that most people are on two sides of the aisle when it comes to EHR data. You have the quality of care and research folks on one side of the aisle that say that they need all of the EHR data from throughout an entire person’s life in order to do their job at the highest level possible. Basically, they want all of the healthcare data collected for an individual available at any time any where.

On the other side of the aisle are the risk management folks who say that keeping the EHR data around opens up an institution to be liable for that data. Instead, if that EHR data is appropriately purged per state and federal record retention guidelines, then the healthcare organization is no longer liable. At least that’s the theory I’ve heard many argue when it comes to retention of health records.

The issue of record retention is not a new one. Many of these discussions happened with paper charts in the past. Do we store the old patient charts or do we shred them? I imagine whatever policy your hospital institution has for old patient charts is how you’re likely to approach EHR record retention as well. Although, the shift to electronic does pose some interesting changes to the dynamics.

For example, many hospitals likely chose to purge paper charts partially based on the cost of storing a large quantity of patient charts that will likely rarely get used. The cost of long term storage of an electronic patient chart is much less than storing a paper chart. Not to mention the cost of electronic storage is going down every day.

Another difference is the accessibility of an old paper chart stored in some offsite storage location. Even if you needed the chart it takes a lot of time to go and retrieve the old paper chart. This is not an issue with old electronic patient charts which can be easily pulled up on any computer.

The challenge for EHR purging is that most EHR vendors don’t provide an EHR chart archive or purge capability. EHR vendors should probably look to PACS and vendor neutral archive vendors for examples of how they do it. They’ve been doing this for a while since the size of the files are so large. Should the EHR data be purged from the main EHR and pushed to more of a document management type of software? These aren’t easy questions to answer.

I’m also reminded of a rural hospital who commented on a previous post I did about purging EHR data. They suggested that in the rural environment where you have deep relationships with all of the patients, it’s unacceptable for them to purge any EHR data. I thought this was an interesting commentary. No doubt the relationship between a rural healthcare provider and their patients has unique features that aren’t experienced in a large city.

What’s your approach to purging EHR data? Which features do you wish were available?

Mostashari Asks EHR Vendors to Do What’s “Moral and Right”

Posted on February 7, 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 13 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.

Healthcare IT News has a good article reporting on what Farzad Mostashari, ONC National Coordinator, said at the Feb 6th Health IT Policy Committee. Farzad doesn’t mince words about some of the things he sees going on in the EHR world. Here’s a section from the above article:

“Vendors do the bulk of the heavy lifting, but as a society, sometimes competition is not in the public interest,” Mostashari said at the latest Feb. 6 meeting. “Government regulation can help in that case, but it’s not the most preferable way.”

“There are some vendors who are ‘beyond the pale’ in their conduct, and it is part of society to create codes of conduct to say this is what we believe in and this is what we do not believe in,” he added.

Mostashari said that some vendors go beyond the boundaries of what society views as proper, in their lack of opaque pricing. He said he gets complaints from providers on a daily basis, saying that some pricing or contract requirements are unfair to them, and asking if there could be some federally regulated norms around pricing.

Farzad also mentioned data lock-in as another place that EHR vendors could do what is legally right, but not necessarily morally right. Farzad called for EHR vendors to do what’s morally right, or else they’re going to go back to the regulation process. Sounds like a threat to me. Although, I’m not sure how much he can really do. Plus, are the EHR vendors that are doing these things going to care?

The other place I’m sure Farzad is thinking about is the closed gardens that so many EHR vendors have created. Farzad asked for the EHR vendors to act as a community. Sounds like a call for EHR vendors to start working together and sharing the healthcare data. HIE is and should be a huge initiative for ONC, and EHR vendors are standing in the way of that happening.

With that said, I’m afraid that Farzad’s call is falling on deaf ears. Most EHR vendors that display these practices know exactly what they’re doing and have already made the choice. They’re unlikely to change because someone in government threatens them with more regulation.

What could have the most affect in this regard is doctors, hospitals and medical groups reading their contracts and not signing contracts with EHR vendors that have language that will cause a problem for the doctor later. Once hospitals stop patronizing EHR vendors that don’t act well, we’ll see some change.

Hospitals Rarely See the Whole EHR Financial Picture

Posted on August 14, 2012 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 13 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.

Chris O’Neal is Managing Partner at KATALUS Advisors. KATALUS Advisors is a strategic consulting firm focused on the healthcare vertical. We serve healthcare technology vendors, hospitals, and private equity groups in North America, Europe, and the Middle East. Our services span growth strategies in new and existing markets, M&A due diligence, market analysis, and advisory services. www.KATALUSadvisors.com

Most hospital CFOs we have worked with readily acknowledge the fact that it is extremely difficult for them to find the time and manpower necessary to build an entire 10-year cost projection for an enterprise IT project. Accounting for every external and internal variable that could affect the total cost of ownership (TCO) is a monumental task and can easily take many weeks and cost tens of thousands of dollars’ worth of internal resources to do so adequately.

While seemingly overwhelming, the additional benefits and possible penalties around EHR purchases should make such a task imperative, especially for cash-strapped hospitals which have no time or financial room for a misstep of such gravity.

In research our team recently conducted on how hospitals estimate TCO for EHR purchases, we found that the real surprises in required cash outflows often come years down the road and outside the scope of traditional cost-estimation models which only reflect near-term purchase and implementation costs. For example, major upgrade (or version upgrade) costs can be a large differentiator in TCO projections. When looking at these upgrades as a percentage of upfront contract value, it is easy to see the importance of having a comprehensive, long-range TCO model which accounts for future costs:

Have you experienced financial “surprises” of your own with unexpected costs?

Epic & Meditech: Distant Cousins?

Posted on July 19, 2012 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 13 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.

Chris O’Neal is Managing Partner at KATALUS Advisors. KATALUS Advisors is a strategic consulting firm focused on the healthcare vertical. We serve healthcare technology vendors, hospitals, and private equity groups in North America, Europe, and the Middle East. Our services span growth strategies in new and existing markets, M&A due diligence, market analysis, and advisory services. www.KATALUSadvisors.com

A recent comment on a blog post suggested that Epic is following a similar trajectory which Meditech pioneered, basically positing that Meditech was the Epic of 15 years ago. This has obviously generated some controversy as knowledgeable folks have taken up both sides of this argument. In reality, there is no clean “yes” or “no” answer. There are key similarities, as well as stark differences in these two vendors.

In terms of similarities, Epic and Meditech both adhere to a common product delivery philosophy in that they build products rooted in a single-database platform. Both companies believe that integration is key to the success of HIT and have continued to develop their products around that philosophy. Both products even share the use of MUMPS as their backend architecture.

Yet, Meditech did something no other vendor was able to do for the longest time: They delivered an integrated enterprise solution at prices which community hospitals could afford. While Meditech racked up win after win in the community hospital space, Epic approached the market from the opposite end of the spectrum by selling their inpatient solutions to the largest hospitals and IDNs. And the price tag reflected the scale of those contracts. Another difference which has been shared by some is the view that Epic is much more controlling in their processes and approach to working with hospitals. Meditech does not have the same “my way or no way” reputation. Additionally, Epic has consistently improved the usability and functionality of their products, while Meditech has released new versions and enhancements at a slower pace.

In the final analysis, it is probably logical to say Epic and Meditech are more dissimilar than they are similar, when both companies are viewed holistically. This is especially true if we consider that Epic is winning the lion’s share of hospital contracts that it goes after, while Meditech, which still maintains the largest hospital customer base in the industry, is working hard to deliver new software to the hospitals it has already won.

Applying EHR Technology to Bad Hospital Processes

Posted on June 19, 2012 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 13 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.

I’ve written many times on EMR and HIPAA about the need to fix the internal workings of your practice before you implement an EHR. The problem being that technology like an EHR work like a great magnifier of any problems with your practice. Something that you may not have noticed as an issue in the paper world can often become a major problem in the EHR world. Not because the problem shouldn’t have been fixed in the paper world, but because you didn’t realize it was a problem.

The core point being, “EHR Technology doesn’t solve bad processes.”

With that as background, I started to think about this from a hospital perspective. Yes, in a small practice it’s much easier to evaluate the relatively simple workflows and dramatically improve them. The same thing is MUCH harder in the incredibly complex hospital world.

In the hospital environment, I expect there are always processes that need improvement. Plus, in many cases the health system is so hardened into its current practices that changing those workflows is almost impossible. This workflow hardening means that hospital EHR vendors are often beholden to old, outdated processes and workflows.

Related to this problem is the view that many hospital EHR vendors (Epic being famous for this) hold about implementing one system across the entire hospital. While you can certainly see advantages to one system, I think a major downfall is that it often means that workflow improvement is much harder.

Those ED EHR vendors have certainly seen this first hand. Imagine how much time and focus a one size fits all hospital EHR spends on an ED EHR module versus an ED EHR vendor that only does ED EHR software. Which of those do you think has a better chance of helping an ED get to the optimal ED EHR workflow? The answer is obvious. Now extrapolate this same concept to the thousands of other workflows that exist in a hospital.

We’re more likely to see hospital innovation from a number of scrappy highly focused startup companies than we are from large hospital EHR vendors. Although, the smartest hospital EHR vendors will realize this and will open themselves up to scrappy highly focused startup companies to iterate on top of their hospital EHR platform. Too bad far too many are focused on putting up walls as opposed to creating highways.

EPIC Workflow Change Requirements

Posted on June 5, 2012 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 13 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.

Katherine Rourke posted a pretty controversial post about EMR Workflow Changes over on EMR and HIPAA. The post has driven a lot of discussion in the comments of the post and on the various social media channels. Although, one comment from Chris Westcott caught my attention today:

This is a very interesting topic! It seems to me the proof is in the putting…. the most successful product, EPIC, generally forces a change in Clinical Workflow. I think this ridgid aspect of their product actually ends up being why they are so successful. What I hear in the market indicates that the more vendors try to adjust to fit various workflows, the less successful the install becomes (especially based on meaningful use metrics).

I have heard that Epic is pretty hard core when it comes to their workflows. Sure, every EHR vendor has plenty of configuration options, but some EHR develop more custom workflows than others. As such, Chris raises an interesting question about whether this rigidity in workflow is one of the reasons that Epic has been so successful.

One thing I’ve seen first hand is that too much massive software customization on the initial install usually leads to a long term pains. Once it’s time to upgrade the EHR software, you’ve usually forgotten all the unique customizations that you’ve made. In many cases, the person that implemented those customizations has left the hospital and so they are no longer there to remind users of the impact an EHR upgrade will have on those customizations.

What do you see? How much clinical workflow should be adjusted during an EHR implementation?

The Argument for Meditech

Posted on October 12, 2011 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 13 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.


Guest Post: Jeremy Bikman is Chairman at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia. www.KATALUSadvisors.com

Why Meditech Continues to Be a Force in HIT
Meaningful Use is a load of white noise, and it could be argued has become a load of something else.
While it is true that certain mandates associated with HITECH are meant to help hospitals achieve real and significant milestones, these mandates also tend to skew and confine the scope of conversation to within narrow clinical parameters. Press releases also reflect this, whether it be Epic’s latest win or the newest Siemens Soarian or McKesson Horizon site to turn on CPOE. What seems to get lost in the noise are the thousands of small and mid-size hospitals and the vendors which serve them. These hospitals provide care for a substantial percentage of the population. This post focuses on one such vendor, Meditech, and the reasons behind its strong position in the industry.

Meditech: By the Numbers
Number of Hospital Clients (U.S.): approximately 2,000
Market Share Position by Total HIS/Core Clinical Installs: 1st
HIS/Core Clinical Offerings: MAGIC, C/S, and 6.0 (with 6.0 as the new standard and go-forward platform)

Serving the Underserved
Small and community hospitals typically have had the fewest choices when selecting a HIS or core clinical vendor. This has always been a function of limited hospital budget, limited IT staff, and the limited number of vendors serving the community and critical access hospital space. Meditech radically changed the paradigm by successfully targeting cash-strapped hospitals and delivering a solution which was both capable and affordable. Specifically, Meditech was able to gain a huge client base by delivering the following:
1. An integrated, comprehensive HIT platform
2. Low upfront and maintenance costs; historically lower priced than any comparable competitor
3. Utilized a proven database technology
Until now, no other vendor has been able to match this value proposition for community hospitals, and without the recent influx of billions of dollars of government funding for HIT spending, it’s unlikely almost any other major vendor could match Meditech’s value proposition today.

What Detractors Say
The following are a series of arguments typically levied against Meditech. Also included are responses which illuminate alternative points of view to these arguments and provide balance to the overall discussion:
Argument: Meditech utilizes old technology.
Response: Meditech’s core technology is really no older than that of the hottest vendor on the market right now – Epic. In fact, they use much of the same technology, with both vendors utilizing a MUMPS database, which is proven as an extremely reliable, fast system.

Argument: Meditech doesn’t support its customers.
Response: No vendor is perfect in customer service and support, and all have room for improvement. That being said, most Meditech customers believe they receive support which meets their expectations. A much higher level of support would require Meditech to hire additional staff and raise its maintenance fees, which would directly hurt their smaller hospital clients.

Argument: Meditech is just about the money.
Response: Let’s set the record straight – every vendor is in business to make money and there is nothing wrong with it. Meditech was certainly late to the game with V6 but so have most of the other major EHR/HIS vendors in the releases of their go-forward “Meaningful Use” compliant solutions. Furthermore, extremely large portions of their customer base are very small hospitals with very small IT budgets that almost no other vendor could afford to support.

Argument: Ok, Meditech might work for smaller hospitals but definitely isn’t suited for larger, more sophisticated ones.
Response: Tell that to Centura Health in Colorado, CHRISTUS Health in San Antonio, Methodist Health System in Dallas, Hospital Sisters Health System in Springfield, IL, or St. Joseph’s Health System out of Orange County, CA. These major organizations are just an example out of a much larger pool of healthcare organizations that are having demonstrable success utilizing Meditech’s core clinical offerings.

Simply put, Meditech is not for everybody, and frankly neither is Cerner, Allscripts, Siemens, McKesson, or Epic. Organizations that go in with their eyes wide open, have committed IT staffs (lead by tough and independent minded executives) and involved physician and nurse leadership can have success with Meditech on par with competing clinical IT solutions.

In summary, Meditech remains a competitive and viable enterprise vendor for hospitals of all sizes. If there is one area where Meditech truly lags behind its competitors it is in the area of trumpeting their every success across the industry. Negative spin has filled this information void. It’s time for Meditech to come back to the HIMSS conference and start making noise on influential HIT websites and blogs to share their clients’ successes and promote its hard-won reputation for value to the industry.

Disclaimer: Meditech is not a client of KATALUS Advisors.

Which Health IT and EHR Vendors Should Critical Access Hospitals Consider?

Posted on September 27, 2011 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 13 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.

The number of health IT and EHR enterprise options available to critical access hospitals is increasing as competition for new hospital contracts moves downstream to smaller facilities. The following is a brief (not all-inclusive) list of health IT and EHR vendors that could be ideal fits for critical access and small, rural hospitals:

  • CPSI: Has done a good job of proving clinical adoption and leads with the most critical access hospital clients doing CPOE.
  • Healthland: Solid system with proven operational capability. Clients give the EMR high marks for usability.
  • HMS: Reinvesting heavily in improving clinical functionality and UI, including a partnership with MEDHOST for strong ED capability.
  • McKesson: Paragon is being considered more often in the critical access space. Has significant sales momentum in larger community hospitals, with some IDN wins.
  • Meditech: Already has a huge client base in larger community hospitals. Small organizations with resources are considering v.6.
  • NextGen: Gets little notice despite having an inpatient offering that is completely integrated with their successful outpatient EMR. Already have a number of clients. Has solid functionality.
  • Prognosis: Exciting new entrant. Applies remote-hosting technology to a single-database inpatient solution for small, rural facilities and critical access hospitals. Already has several clients.

These health IT and EMR vendors represent a mix of those who have caught the attention of smaller facilities, those who represent a new and intriguing competitive advantage, and those who have proven able to deliver products in a small hospital environment.

See also our list of hospital EMR and EHR vendors.

Chris O’Neal is Managing Partner at KATALUS Advisors. KATALUS Advisors is a strategic consulting firm focused on the healthcare vertical. We serve healthcare technology vendors, hospitals, and private equity groups in North America, Europe, and the Middle East. Our services span growth strategies in new and existing markets, M&A due diligence, market analysis, and advisory services. www.KATALUSadvisors.com