Epic Systems | Hospital EMR and EHR

Judy Calls Epic “Most Open System I Know”

After Zina Moukheiber from Forbes was declined an interview with Judy Faulkner, CEO of Epic, last year Judy decided to talk to Zina about Epic in this article “An Interview With The Most Powerful Woman In Health Care.” Zina does a nice job on the interview and raises some of the questions many people have about Epic. It’s worth a read if you like to follow the hospital EHR world.

Many people are likely going to latch on to Zina calling Judy Faulkner the “most powerful woman in health care.” I don’t think that’s really up for discussion. Judy is the most powerful woman in healthcare and so I’m really glad that Judy is starting to join the discussion about Epic and healthcare. She has an important voice in the discussion and we need her participation. Although, I’m sure she’ll hate being called a billionaire in the article. The reality is we don’t know how much Judy’s really worth until we know how much Epic is worth and I’m not sure Epic plans to go public anytime soon.

Semantics aside, the most important part of the interview was the discussion of Epic being a closed system to which Judy frankly replied, “We are the most open system I know because we’re built as a database management system, and database management systems need to allow their users to mold it to what they need.” I think she really believes that Epic is an open system and quite frankly there aren’t that many in healthcare she can look to that are more open. Sure, a number of EHR vendors have worked to be more open, but even they aren’t as open as many other non health IT software systems. Maybe Judy hasn’t looked at the APIs outside of healthcare.

The real disconnect I had when reading Judy’s thoughts on being open is her lack of understanding of how a truly open API works. In a well implemented API, you can allow any and all programmers to be able to build applications on top of your software without those programmers needing to read your code and study your internal software. I’m not saying you don’t want and need to have an application and verification process for those people who want to tap into your API. This can be part of the process, but a well implemented and documented API can be open to everyone interested in building on top of your software. The value Epic would receive from so many companies iterating and extending the core Epic functionality would be amazing.

The other facet of Epic openness discussed in the article was around interoperability. Judy offered these comments on Epic’s ability to share patient records:

As of March 2013, our customers exchanged 760,000 patient records per month; about one-third were with non-Epic systems. Based on the historical trajectory, we expect that we’re closer to exchanging approximately one million records per month. We are currently exchanging data with Allscripts, Cerner, Department of Defense, Veteran Affairs Administration, Social Security Administration, eHealth Exchange (formerly Nationwide Health Information Network), Greenway, MEDITECH, NextGen and others. We expect to be exchanging data soon with eClinicalWorks, General Electric, Surescripts, and others.

This sounds good on face, but lets consider how many records Epic is sharing. Let’s use the round number of 1 million patient records shared per month. The article says that Epic has about half of the US population on Epic, or about 150 million patients. That means that about 0.67% of Epic’s patient records are being shared.

I’m happy to applaud Epic for sharing 1 million records a month with so many different vendors. My only complaint is that they could do so much more. For example, if you can share records between Epic and Cerner now, does that work for all Epic hospitals or do you have to do the new integration with every hospital that says they want to share records with Cerner? If it was a turn key way to integrate with Cerner, I’m quite sure that instead of 1% of Epic’s patient records being shared we’d see tens of millions of patient records flowing where they needed to go.

Many might remember my surprise breakfast with Judy Faulkner at the CHIME Forum. From my personal experience, Judy is not the black widow that I’ve heard many portray her to be. In fact, I found her incredibly thoughtful, caring, and really interested in quality patient care. That’s why I hope Judy will see that she’s sitting on an opportunity to do so much more than she’s doing now. Although, it will take a shift in her understanding of what it means to be an open EHR. Right now it seems her mostly unfounded fears won’t let her see the possibilities.

Epic Module Targets Patients For Care Coordination

At Gundersen Lutheran Health System, executives have put together a program to target the 1 to 2 percent of those most likely to be hospitalized, seen in the emergency department or face other complications. To manage the program, the La Crosse, Wis.-based system is leveraging a feature of their Epic EMR which sifts out the patients most in need of additional care coordination, reports Health Data Management.

Gundersen Lutheran is targeting complex patients with its program, but not just those with medically-complex conditions. They’re also hoping to find patients who, while they might have simpler conditions, live alone or have trouble following sometimes difficult medical care plans. The system is using the EMR first to identify the patients, then to treat them, according to Health Data Management.

To find patients in need of extra care coordination services, Gundersen is using a “tiered scoring” module built in to the Epic platform which includes one component for medical complexity and another to measure psycho-social issues. When clinicians want to refer a patient to the care coordination program, physicians use the Epic scoring tool to see if the patient qualifies. Clinicians can also notify the care coordination team using the Epic system, in three clicks or less, noted Beth Smith, R.N., executive director of patient and family-centered care at the health system.

The patients identified by the scoring model as in need of extra care coordination are farmed out to a group of 22 nurses and social workers, whose job it is to monitor the care of these complex patients who are more likely to face adverse events.

The workload the care coordinators face is intense. Typically, care managers are supervising some 1,700 patients each, who not only stay in touch with patients but also attend office visits and follow through with specialists. Epic plays a role here too, however. Care coordinators get a special tab in the Epic EMR which pulls key elements of the patient’s history into a single view, making it easier to get a sense of the whole patient. Epic also notifies them via a message in the system if a patient shows up in the ED.

According to Health Data Management, this program has helped stabilize hypertensive and diabetic patients, with just under half showing sustained improvements over a two-year period.

Post a Comment(0)

May 15, 2013 I Written By Anne Zieger

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.

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

Tags:Care Coordination Epic Epic EMR Epic Systems Gundersen Lutheran Health System

Cleveland Clinic Brings Epic Smarts To NY Hospital Practices

The Cleveland Clinic is going the consulting route, this time around by working with the physician and specialty practices for a New York hospital to bring Epic up to speed.

Glens Falls is a 410-bed nonprofit which began implementing the Epic EMR in early 2012. The New York facility has 3,000 employees and 28 regional locations.

Apparently dissatisfied with its internal knowledge base on the subject, It’s now contracted with the Clinic’s MyPractice Healthcare Solutions (MPHS) to help deploy and optimize its rollout, reports the Cleveland Plain Dealer.

Among the Epic products installed at Glens Falls is “MyChart,” offering a clinical and billing records portal for patients, according to the Plain Dealer.

The Cleveland Clinic has had Epic in place for more than 10 years, making it one of the first healthcare systems in the country to install the vendor’s product. Having learned from that experience, Cleveland Clinic MPHS now brings project management and implementation expertise to other facilities.

I think this is an interesting business model for the Cleveland Clinic, and I’d be curious to see what other consulting agreements it has put into place. (So far I wasn’t able to turn up any others but my guess is that they exist.)

It seems to me that hospitals who have tamed Epic — Kaiser Permanente comes to mind — might very well go into this line of business, as the need is great. Not to mention that if I were making a decision as to who I’d hire to wire my medical practice into my hospital, a successful institution would have a very strong pitch to make.

Can any of you readers share other examples of hospitals/clinics who are turning their Epic experience into a consulting revenue stream?

Post a Comment(0)

May 13, 2013 I Written By Anne Zieger

Filed Under: Community Hospitals 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 Hospital IT Systems

Tags:Cleveland Clinic Epic Epic EMR Epic Systems Glens Falls Hospital

Epic Installation Fuels Maine Controversy

Ordinarily, the fact that integrated delivery system MaineHealth had spent $150 million on an Epic EMR system wouldn’t excite a lot of comment. After all, say what you like about Epic, it doesn’t come cheaply, and a $150 million install is at the low-ish end of what hospitals are spending to put the vendor’s system in place.

This time, though, the health system is taking fire from the community, in part because it’s decided to close 22-bed St. Andrews Hospital in Boothbay Harbor, reports EHR Intelligence.

In an open letter published in the Boothbay Register, local selectman and St. Andrews Regional Task Force member Stuart Smith argues that the Epic install cost is “extremely high.”

Smith also notes that Maine Health has had a bad time with the installation, which was supposed to go live on December 1, 2012 and now looks as though it won’t go live until 2015. As Smith sees it, a lot of money and time is being wasted on the Epic project:

Millions of dollars have been charged to member hospitals and staff time (salaries and mileage) over the past 2–3 years with no benefit. The system failure also adds operational costs going forward that were not planned for and regional consolidation of finance will now be delayed.

As things stand, Smith notes, the planned closure of St. Andrews is part of a larger shuffle moving urgent and emergency services around which has led to roughly $2 million in losses for the facility.

With St. Andrews wobbly, leaders are considering merging it with struggling Miles Memorial Hospital, a combination which could allow its owners to keep $5 million in federal reimbursement by keeping its critical access hospital designation.

Is Epic Stifling Health IT Innovation?

In many ways and definitely based on the buzz, Epic is at the top of the hospital EMR market. According to one estimate, about 40 percent of the U.S. population has its medical information stored in an Epic EMR, a stunning number given the level of competition in the hospital EMR space.

The question is, what impact is that having on the EMR marketplace? According to one piece posted this week by Medical Economics, Epic may be stifling health IT innovation due to its nearly-unassailable market lead.

As readers probably know, Epic has established an empire built around antiquated technology (MUMPS), which essentially forces any company that hopes to interoperate to bear its MUMPS core in mind. We’re talking the blunted edge here.

Perhaps more importantly, now that Epic has such a dominant market share, if it chooses to keep a closed system in place, customers will only get what innovations are driven internally by Epic. If hospitals want innovations emerging outside the Epic bubble, they’ll have to consider the staggering costs — in some cases in the hundreds of millions of dollars — of switching outright to another vendor. If that doesn’t stifle innovation I don’t know what does.

This situation hasn’t been lost on healthcare industry leaders, some of whom have begun to balk at Epic’s rise, Medical Economics reports.

As the piece notes, Epic has attracted outspoken critics that question whether Epic’s’ market dominance is bad for the health IT world as a whole. One of those critics is Paul Levy, former CEO of Beth Israel Deaconess Medical Center, who has taken shots at the EMR giant from his “Not Running A Hospital” blog.

Levy, who Medical Economics cites as one of Epic’s toughest opponents, has been known to compare customers’ relationship with Epic to Stockholm Syndrome, a condition occurring when hostages begin to sympathize and identify with their captors.

All that being said, at the moment, there’s little critics can do to change Epic’s business practices or development plans. Perhaps the Federal Trade Commission will step in at some point if it appears to staff there that Epic’s market control is anti-competitive. In the mean time, though, Epic seems to have a lock on the hospital marketplace — and a disproportionate role in shaping the future of EMRs generally.

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.

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.

Post a Comment(0)

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

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.”

Post a Comment(0)

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

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.

Post a Comment(0)

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

Do Epic Customers Have EMR Stockholm Syndrome?

John’s Note: I guess Anne didn’t see my post about the EMR Stockholm Syndrome. I think she adds to the discussion with this post though.

According to a recent piece appearing in KevinMD.com, by next year an astonishing 40 percent the U.S. population will have their medical data stored in an Epic system. Heaven only knows how many billions of dollars of IT capital outlay that represents. What we can safely guess is that not a single customer making up that list failed to make painful sacrifices to bring Epic on board.

Having spent so much and worked so hard to get Epic up and running, you’d expect to hear at least some complaints from hospital C-suites about the ordeal of it all. And despite its popularity, you’d expect far more hospitals to blanch at the, uh, epic price tag on an Epic install and say “no thanks.” But instead, you see hospital leader after hospital leader speaking glowingly about Epic and choosing it over competitors time and time again.

As author Paul Levy notes (himself the former CEO of Beth Israel Deaconess Medical Center), Epic isn’t just expensive. It’s also something of a pain to work with:

* Epic has made a policy of not being interoperable with other EMRs, scuttling HIE plans that have become increasingly important to hospital business plans

* Epic decides when system upgrades are needed and changes to the EMR are needed

What Paul doesn’t mention, but is worth considering as well, is that Epic only gets installed if you work with teams of its relatively green staff members, hotshot types in their twenties who may be very smart are definitely on the arrogant side if reports I’ve heard are true.

So, if hospitals are still singing Epic’s praises after all of this stress and expense and letting a vendor dictate important aspects of its development roadmap, is the industry suffering from Stockholm Syndrome (a feeling of bonding with people who have captured you)? As Levy sees it, the answer seems to be yes. What do you think?

Judy Calls Epic “Most Open System I Know”

Epic Module Targets Patients For Care Coordination

Cleveland Clinic Brings Epic Smarts To NY Hospital Practices

Epic Installation Fuels Maine Controversy

Is Epic Stifling Health IT Innovation?

ONC Proposes New EMR Vendor Fee

Best Of Breed Systems Lead In Battle For Meaningful Use Dollars

Epic Not Invited To CommonWell Interoperability Alliance

Top 10 Hospital EHR Vendors By Installed Systems

Do Epic Customers Have EMR Stockholm Syndrome?

Recent Posts

Calendar

Hospital EMR & EHR Resources

Recent Comments

Categories

May 2013
M	T	W	T	F	S	S
« Apr
		1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30	31