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Would Cerner DoD Loss Seal Its Fate As An Also-Ran?

Posted on July 29, 2015 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.

Update: Cerner has been announced as the winner of the DoD EHR Contract.

As everyone knows, Epic has attained a near-unbeatable place in the race for U.S. hospital market share. By one important criterion, Meaningful Use attestations, Epic has the lead hands down, with about 186,000 attestations as of March 2015 compared with 120,331 attestations on Cerner systems.

That being said, Cerner is hardly an insignificant force in the hospital EMR marketplace. It’s a multibillion-dollar powerhouse which still holds a strong #2 position and, if a casual survey of Web and social media commentary is to be believed, has done far less to alienate its customers with high-handed tactics. And while Cerner systems are far from cheap, you don’t regularly see headlines citing a Cerner investment as pivotal in a hospital’s credit rating taking a pratfall. Also, Cerner has the most contracts with MU-eligible hospitals, holding contracts with about 20% of them.

Nonetheless, there’s an event looming which could tip the scales substantially further in Epic’s direction. As many readers know, Epic is part of a team competing for the Department of Defense’s $11B Healthcare Management Systems Modernization contract (Word on the street is that we could hear the winner of the DoD EHR bid this week). I’d argue that if Epic wins this deal, it might have the leverage to push Cerner’s head under water once and for all.  Cerner, too, is fighting for the deal, but if it wins that probably won’t be enough to close the gap with Epic, as it’s harder to play catch up than to zoom ahead in a space you already control.

Now my colleague John argues that winning the DoD contract might actually be bad for Epic. As he sees it, losing the DoD deal wouldn’t do much damage to its reputation, as most hospital leaders would understand that military healthcare bears little resemblance to commercial healthcare delivery. In fact, he contends that if Epic wins the contract, it could be bad for its customers, as the Verona, Wisc.-based giant may be forced to divert significant resources away from hospital projects. His reasoning makes sense.

But losing the DoD contract would almost certainly have a negative impact on Cerner. While Epic might not suffer much of an image loss if it loses the contest, Cerner might. After all, it doesn’t have quite the marquee list of customers that Epic does (such as the Cleveland Clinic, Massachusetts General Hospital, Mayo Clinic and the Johns Hopkins Hospital). And if Cerner’s rep suffers, look out. As a surgeon writing for investor site Seeking Alpha notes, the comparatively low cost of switching TO Cerner can just as easily be used as a reason to switch AWAY FROM Cerner.

What’s more, while Cerner’s acquisition of Siemens’ health IT business — adding the Soarian product to its stable — is likely to help the company differentiate itself further going forward, but that’s going to take a while.  If Cerner loses the DoD bid, the financial and PR hit could dampen the impact of the acquisition.

Net-net, I doubt that Cerner is going to lie down and play dead under any circumstances, nor should it. Epic may have a substantial advantage but there’s certainly room for Cerner to keep trucking. Still, if Cerner loses the DoD bid it could have a big impact on its business. Now is the time for Cerner to reassure current and potential customers that it’s not planning to scale back if Epic wins.

Why Not “Meaningful Interoperability” For EMR Vendors?

Posted on July 28, 2015 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.

At this point, arguably, Meaningful Use has done virtually all of the work that it was designed to do. But as we all know, vendors are behind the curve. If they aren’t forced to guarantee interoperability — or at least meet a standard that satisfies most interconnectivity demands — they’re simply not going to bother.

While there’s obviously a certification process in place for EMR vendors which requires them to meet certain standards, interoperability seemingly didn’t make the cut. And while there’s many ways vendors could have shown they’re on board, none have done anything that really unifies the industry.

PR-driven efforts like the CommonWell Alliance don’t impress me much, as I’m skeptical that they’ll get anywhere. And the only example I can think of where a vendor  is doing something to improve interoperability, Epic’s Care Everywhere, is intended only to connect between Epic implementations. It’s not exactly an efficient solution.

A case in point: One of own my Epic-based providers logged on to Care Everywhere a couple of weeks ago to request my chart from another institution, but as of yet, no chart has arrived. That’s not exactly an effective way to coordinate care! (Of course, Epic in particular only recently dropped its fees for clinical data sharing, which weren’t exactly care coordination-friendly either.)

Increasingly, I’ve begun to think that the next stage of EMR maturation will come from some kind of “Meaningful Interoperability” incentive paid to vendors who really go the extra mile. Yes, this is iffy financially, but I believe it has to be done. As time and experience have shown, EMR vendors have approximately zero compelling reasons to foster universal interoperability, and perhaps a zillion to keep their systems closed.

Of course, the problem with rewarding interoperability is to decide which standards would be the accepted ones. Mandating interoperability would also force regulators to decide whether variations from the core standard were acceptable, and how to define what “acceptable” interoperability was. None of this is trivial.

The feds would also have to decide how to phase in vendor interoperability requirements, a process which would have to run on its own tracks, as provider Meaningful Use concerns itself with entirely different issues. And while ONC might be the first choice that comes to mind in supervising this process, it’s possible a separate entity would be better given the differences in what needs to be accomplished here.

I realize that some readers might believe that I’m dreaming if I believe this will ever happen. After all, given the many billions spent coaxing (or hammering) providers to comply with Meaningful Use, the Congress may prefer to lean on the stick rather than the carrot. Also, vendors aren’t dependent on CMS, whose involvement made it important for providers to get on board. And it may seem more sensible to rejigger certification programs — but if that worked they’d have done it already.

But regardless of how it goes down, the federal government is likely to take action at some point on this issue. The ongoing lack of interoperability between EMRs has become a sore spot with at least some members of Congress, for good reasons. After all, the lack of free and easy sharing of clinical data has arguably limited the return on the $30B spent on Meaningful Use. But throwing the book at vendors isn’t going to cut it, in my view. As reluctant as Congressional leaders may be to throw more money at the problem, it may be the only way to convince recalcitrant EMR vendors to invest significant development resources in creating interoperable systems.

Partners Goes With $1.2B Epic Installation

Posted on June 2, 2015 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.

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.

As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.

The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.

The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.

Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)

According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.

Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.

Is Epic Too Big To Fail?

Posted on May 27, 2015 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.

While there’s a chance an Epic purchase can endanger a hospital’s financial health, I’ve never heard a whisper of gossip suggesting that Epic is in financial trouble.

In fact, it appears virtually unstoppable. Though Epic is a private company, and doesn’t disclose its financial information, its 2014 revenue was estimated at $1.75 billion, up from $1.19 billion in 2011. And despite the fact that the hospital EMR market is getting saturated, the giant EMR vendor is doing quite nicely with the estimated 15% to 20% of the market it is reported to hold.

Still, what would happen if Epic took a body blow of some kind and stopped being able to support the implementation and operation of its products?  After all, buying an EMR isn’t like picking up, say, a fleet of trucks that the hospital services and maintains. For years — sometimes a decade — after a hospital goes with Epic, that hospital is typically reliant on Epic to help keep the EMR lights on.

Which brings me to my core question: Is Epic too big to fail? Would it create such a disaster in the healthcare market that the U.S. government should step in if Epic ever had a massive problem meeting its commitments?

As little as I like saying so, there’s a strong argument to be made that Epic simply can’t be allowed to stumble, much less crumble.

As of April 2014, Epic reportedly had 297 customers, a number which has undoubtedly grown over the past year. What’s more, 70% of HIMSS Analytics Stage 7 hospitals, i.e. hospitals for which their EMR is absolutely mission critical, use the EpicCare inpatient EMR.

If Epic were to face some financial or operational disaster that prevented it from supporting its hospitals customers, those hospitals would be very compromised. Epic’s customers simply couldn’t leap abruptly to, say, a competing Cerner system, as the transition could take several years.

Depending how far along in their Epic install and launch they were, hospitals might try to limp along with the technology they had in place, switch temporarily to paper records or try to keep their progress going with whatever Epic consultants they could find.

In an effort to recover from the loss of Epic support, hospitals would be forced to bid high for the services of those consultants. Hospitals could have their IT budgets decimated, their credit harmed or even be driven out of business.

In the crazy shuffle that would follow, there’s little doubt that many medical errors would occur, some serious and some fatal. It’s impossible to predict how many errors would arise, of course, but I think it’s easy to argue that the number would be non-trivial.

Given all this, the feds might actually be forced to step in and clean up Epic’s mess if it made one. Mind you, I’m not saying that, say, HHS has such a plan in place, but perhaps it should.

Ultimately, I think the healthcare industry ought to do some self-policing and find some ways to reduce its reliance on a single, frighteningly-powerful vendor. Over time, I believe that will involve gradually shifting away from reliance on existing EMRs to next-gen EMRs built to support value-driven payment and population health analysis. In the mean time, we’d better hope nobody drops a giant rock on Epic’s executive headquarters.

Erlanger Health System Takes A Chance On $100M Epic Plunge

Posted on May 11, 2015 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.

The seemingly eternal struggle between EMR giants Cerner and Epic Systems has ended in another win for Epic, which was the final choice of Chattanooga, TN-based Erlanger Health System. The health system’s CEO, Kevin Spiegel, who said that Cerner had been its other finalist, announced last week that Erlanger would spend about $100 million over 10 years for the Epic installation.

Erlanger, a four-facility public hospital system with about 800 total beds, is an academic medical system and serves as a campus of the University of Tennessee College of Medicine. The system also partners with UT to operate the UT Erlanger Physicians Group, a 170-member multispecialty practice.

The health system, which fell in financial trouble in 2012, only recently saved itself and positioned itself for the massive Epic investment. It closed out FY 2014 with $618M in total operating revenue and $18M in operating income.

Erlanger’s turnaround is all well and good. But that being said, these numbers suggest that Erlanger is making something of a gamble by agreeing to an approximately $10M a year health IT investment. After all, the health system itself concedes that its return to financial health came in large part due to $20 million in new Medicare and Medicaid funding from CMS, along with new funding from the state’s Public Hospital Supplemental Payment Pool. And politically-obtained funds can disappear with the stroke of a pen.

The risky nature of Erlanger’s investment seems even more apparent when you consider that the system has an aggressive building plan in place, including a new orthopedic center, a $68M expansion of one of its hospitals, a 100,00 square foot children’s & women’s ambulatory center and a new health sciences center. Particularly given that Erlanger just completed its turnaround last year, does it make sense to squeeze in Epic payments alongside of such a large capital investment in infrastructure?

What’s more, the health system has a bond rating to rehabilitate. Faced with financial hardships in 2013, its bond rating was downgraded by Moody’s to a Baa2 and the system’s outlook was rated “negative.” By 2014, Erlanger’s had managed to boost the Moody’s outlook to “stable,” in part due to the influx of state and federal funds obtained by Erlanger execs, but the Baa2 rating on its $148.4 million in bond debt stayed in place.

While I imagine the hospital will realize a return on its Epic spending at some point, it’s hard to see it happening quickly.  In fact, I’d guess that it’ll be years before Erlanger’s Epic install will be mature enough to be evaluated for ROI, given the level of effort it takes to build a mature install.

In the meantime, Erlanger leaders may be left wondering, from time to time at least, whether they really can afford their expensive new EMR.

Four Things You Should Know About Deloitte’s “Evergreen” EHR Program

Posted on February 20, 2015 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.

Recently, consulting giant Deloitte announced a new program, named “Evergreen,” designed to cut down the cost of implementing and operating hospital EHRs. Unfortunately, much of the Evergreen coverage in the health IT trade press was vague or downright wrong, as it suggested that Deloitte was actually going into the EHR business itself. The key point Deloitte sought to make — that it could implement and operate EHRs for 20% to 30% less than hospitals — did come across, but the rest was a bit jumbled.

Having spoken to Mitch Morris, global healthcare leader for Deloitte Consulting LLP, I can clarify much of what was confusing about the Evergreen announcement and subsequent coverage.  Here’s some key points I took away from my chat with Morris:

  • Evergreen is a suite of services, not a product:  Though some HIT editors seem to have been confused by this, Evergreen isn’t an EHR offering itself.  It’s a set of EHR implementation and operation services provided by Deloitte Consultants. Evergreen also includes a financing scheme allowing hospitals and health systems to obtain a new EHR by making a series of equal payments to Deloitte over five to seven years. (“It’s like leasing a car,” Morris noted.) This allows hospitals to get into the EHR without making an enormous upfront capital investment over the first 18 months.
  • Evergreen is only offered in tandem with an Epic purchase:  The Evergreen program arose from what Deloitte learned after doing a great deal of work with Epic EHRs, including the famous multi-billion install at Kaiser Permanente and an extensive rollout for large hospital system Catholic Health Initiatives. So at the outset, the program is only available to hospitals that want to go with Epic.  Deloitte is considering other EHR vendors for Evergreen partnership but has made no decisions as to which it might add to the program.
  • Both onshore and offshore services are available through Evergreen:  One might assume that Deloitte is offering lower implementation and operation costs by offshoring all of the work.  Not so, Morris says. While Deloitte does offer services based in India and Ireland, it also taps U.S. operations as needed. Clients can go with offshore labor, onshore labor or a mix of services drawing on both.
  • This is a new application services management offering for Deloitte:  While the consulting giant has been managing Oracle and SAP installations for clients for some time, managing EHR platforms is a new part of its business, Morris notes.

According to Morris, Deloitte expects Evergreen customers to include not only health systems and hospitals that want to switch EHRs system-wide, but also those which have done some acquisitions and want to put all of their facilities on the same platform. “It’s expensive for a health system to maintain two or three brands, but they often can’t afford the upfront capital costs of putting every hospital on the same EHR,” he said. “We smooth out the costs so they can just make a payment every month.”

This could certainly be a big score for Epic, which is likely to scoop up more of the EHR-switching systems if Deloitte helps the systems cope with the costs. And Deloitte is likely to get many takers. Let’s see, though, whether it can actually follow through on the savings it promises. That could change the EHR game as we know it.

Another Health System’s Finances Weighed Down By Epic Investment

Posted on December 26, 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.

While Memphis-based Baptist Memorial Health Care Corp. may intend to be “the high-quality and low-cost provider” in its region, spending $200 million on an EMR purchase has got to make that a bit more, shall we say, challenging.

While health systems nationwide are struggling with issues not of their own making, such as some states’ decision not to expand Medicaid, it appears that Baptist Memorial’s financial troubles have at least some relationship to the size of its 2012 investment in an Epic EMR platform.

Baptist, which let 112 workers go in September, has seen Standard & Poor’s lower its long-term rating on the health system’s bond debt twice since mid-2013.  Through June, the system’s losses totaled $124 million, according to S&P.

Baptist employs 15,000 workers at 14 hospitals located across the mid-south of the US, so the staffing cuts clearly don’t constitute a mass layoffs. What’s more, the layoffs are concentrated corporate services, Baptist reports, suggesting that the chain is being careful not to gut its clinical services infrastructure. In other words, I’m not suggesting that Baptist is completely falling apart, Epic investment or no.

But the health system’s financial health has deteriorated significantly over the past few years. After all, back in 2009, S&P gave Baptist Memorial a long-term ‘AA’ rating, based on its strong liquidity and low debt levels; history of positive excess income and good cash flow; and solid and stable market share in his total surface area, with favorable growth in metropolitan Memphis.

However, at this point Baptist is clearly struggling, so much so that is taking the extraordinary step of cutting the salaries of top executives in the system by 22% to 23%. That includes cutting the salary of health system CEO Jason Little. But this is clearly a symbolic gesture, as executive pay cuts can’t dent multimillion dollar operating revenue shortfalls.

So what will help Baptist improve its financial health? In public statements,  Baptist CEO Little has said that the hospitals’ length of stay has been excessive for the compensation that they get from payers, and that fixing this is his key focus. This problem, of course, is only likely to get worse as value-based reimbursement becomes the rule, so that strategy seems to make sense.

But Baptist is also going to have to live with its IT spending decisions, and it seems obvious that they’ve had long-term repercussions. I don’t think any outsider can say whether Baptist should have bought the Epic system, or how much it should have spent, but the investment has clearly been a strain.

Epic Hires DC Lobbying Firm To Fight Closed-System Reputation

Posted on September 15, 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.

For quite some time, everybody’s favorite EMR giant has a “no marketing, no government relations” policy. (In fact, Epic staffers really seem to hate journalists, but maybe they just don’t like me — who knows?)

Anyway, a few weeks ago, reports the ever-watchful HISTalk, it came out that Epic has broken its rule, hiring on DC lobbying firm Card & Associates. While you might think Epic would hire a billion-dollar behemoth, Card is a smallish firm with seven modest accounts and only one healthcare client. It must help, however, that Card is run by the brother of the former White House Chief of Staff under Pres. George W. Bush.

So what made Epic change its standard operating procedure and begin lobbying The Hill? In its federal lobbying disclosure, the EMR firm says that it’s begun lobbying to “educate members of Congress on the interoperability of Epic’s healthcare information technology.”

The timing of the outreach effort isn’t a coincidence, Modern Healthcare astutely notes. As you read this, a team made up of Epic, IBM and a handful of other technology giants are fighting other equally ferocious IT firms to win the roughly $11 billion contract to update the Department of Defense’s clinical systems.

While none of its contract competitors have a strong reputation for interoperability, Epic is seen as much worse, with a RAND Corp. study released in July calling Epic’s systems “closed records.” That had to hurt.

Unless Epic plans to hold health IT classes for Congress over the next several years, I doubt they’ll be able to make their point with largely Luddite Senators and Representatives in Washington on a technical basis. That is, Epic’s lobbyists won’t be able to convince legislators that Epic is interoperable on the merits.

But lobbyists may very well be able to break the ice on The Hill, and sell the idea that those mean, bad old health IT competitors haven’t been telling the truth about Epic. The pitch can include the somewhat matronly CEO, Judith Faulkner, who doesn’t look like the most powerful woman in healthcare or a competitor that would gladly bite your head off and spit it down your neck. Then they can roll out Epic’s pitch that its systems actually are interoperable (between other Epic installs at least). If it sticks even a little bit, whatever the $1.7 billion company spent will have been worth it.

Frankly, I find the idea of portraying Epic as an underdog in any way as downright laughable, and I bet you do too. But I simply can’t imagine another pitch that would work.

Sutter Health Ready To Deploy HIE, But Can It Succeed?

Posted on June 30, 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.

Sutter Health doesn’t have a great reputation when it comes to EMR implementation. Late last year, when we reported that Sutter’s Epic EMR crashed for an entire day, comments came pouring in about the company’s questionable approach to training its staff on using the system.

According to Epic consultants who’d been involved in the project, Sutter leaders decided that Epic experts were there to “facilitate” training done by inexperienced in-house teams, rather than actually teach key users what they need to know. The result was strife, disorder and anxiety, according to several consultants who’d been involved. Since then, Sutter has connected its EMR to five medical foundations and 17 hospital campuses; by next year, it expects the EMR to connect to information on 3 million patients. But there’s no reason to think it’s changed its training strategy, which could cast a bit of a pall over the new project.

Now, Sutter Health is building out a health information exchange, working with Orion Health, which will tie together hospitals and doctors both inside and outside of its network across northern California. Sutter plans to begin deploying the HIE in phases this summer, starting with data integration with the Epic EMR and extending to testing exchange of inbound and outbound data. If the project works out, it seems likely that it will be a plus for every provider that does business with Sutter.

The question is, will Sutter do a better job of managing this process than it did in rolling out its EMR? While it’s easy to boast that your plans are going to be a “gamechanger” for the market, it’s hard to take that claim at face value when your EMR implementation hasn’t gone so splendidly.

Certainly, Orion is a reputable HIE vendor which has been praised for having strong products and service. And Sutter certainly has the financial wherewithal to see such an effort through. The thing is, if Sutter leaders (seemingly) took a wrongheaded approach to the all-important issue of EMR training, who knows what curveballs they might throw into the process of rolling out an HIE? Even if its EMR has stabilized and Sutter has somehow gotten past its training hurdles, its past missteps don’t inspire confidence.

If I were with Orion, I’d draw a firm line where training was concerned, as Sutter’s past strategy only seems to have cast its last major HIT vendor in a bad light. If not, I’d make sure the contract had a workable bailout clause…or be prepared for some serious headaches.

What Can Go Wrong With An Epic Implementation

Posted on December 9, 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.

With Epic owning the lion’s share of new EMR implementations — it has as many in progress or planned as all other major vendors combined — it’s good to stop and look at just what can go wrong with an Epic implementation.

After all, while Epic installations are a fact of life, all of the news they generate isn’t good. In fact, a growing number of stories of botched Epic installs and institutional fallout are beginning to mount.

In an effort to do learn more about Epic’s strengths and weaknesses, researchers at The Advisory Board Company interviewed some of Epic’s most experienced U.S. hospital customers, as well as some of the busiest Epic implementation consultants, writes senior research director Doug Thompson.

As Thompson points out, the problems Advisory Board identified could impact any big EMR install, but with Epic in the lead, it doesn’t hurt to focus on its products specifically.  (By the way, according to the Advisory Board, there were 194 Epic installs in process or contracted for 2012 and 2013; the closest competitor, MEDITECH, had 59 and Cerner came in at 55.)

So what’s behind the stumbling? Thompson names several limitations to Epic’s own approach to implementation, including the following:

* Its young implementation staffers may be enthusiastic, but some lack operational experience in hospitals or medical practices, which means they rely heavily on Epic’s standard methods and tools –and that may not be adequate for some situations.

* Though Epic’s recommended implementation staffing numbers are higher than that of most other EMR vendors, their estimate nonetheless falls short often by 20 percent to 30 percent of the need.

*Epic’s “foundation” (model) installation plan limits customization or extensive configuration until after the EMR has gone live, which can lead to less physician buy-in and end-user cooperation.

To address these concerns, Thompson offers fourteen techniques to help hospitals get the value they want.  Some of my favorites include:

Begin with the end in mind: Make sure your facility has specific, measurable benefits they hope to achieve with your Epic implementation, and prepare to measure and manage progress in that direction.

Governance: Make sure you assign appropriate roles and responsibilities in managing your Epic rollout and ongoing use. While IT will serve as the linchpin of the project, of course, it’s critical to make sure the appropriate operations leaders have a clear sense of how Epic can and should affect their areas of responsibility.

Get outside input on project staffing: While Epic is upfront about the need for extensive staffing in its implementation, as noted its estimates still come in rather low. It’s a good idea to get in objective outside estimate as to how big the project staff really needs to be.

For more information, I highly recommend you read the full Advisory Board brief. But in short, as  the report concludes, it seems that relying too much on Epic’s approach, staff and tools can lead to problems. Surprised?