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What Can Go Wrong With An Epic Implementation

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?

December 9, 2013 I Written By

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.

Epic Implementation Problems Lead To Lower Hospital Credit Rating

Of late, stories have begun to crop up about troubled Epic implementations and the financial problems that these shaky implementations can cause. In fact, we’re aware of at least one Epic investment which may have led to the departure of a CIO from a Maine hospital.

Now, we’re told that a troubled Epic implementation has led to the lowering of a hospital’s credit rating. Standard & Poor’s has lowered Winston-Salem, NC-based Wake Forest Baptist Medical Center’s debt from AA- to A+, primarily due to the problems Wake Forest has had in rolling out Epic, according to Becker’s Hospital Review.

According to a statement from Wake Forest, the EMR implementation had a bigger impact on the hospital’s finances and operations than it had anticipated, leading to poorer overall fiscal performance than expected for 2013. Earlier this year, the CIO for Wake Forest resigned in the wake of the Epic debacle.

Wake Forest spent about $13.3 million to bring Epic on board, and roughly $8 million on Epic-related expenses, but that doesn’t seem to have been the main reason the install caused financial problems. We know from a report in the Winston-Salem Journal that since the Epic rollout, the hospital said that it had lost $26.6 million in margin due to volume disruption caused by Epic-related problems.

The Epic implementation wasn’t the only reason for the downgrade. It came partly due to cuts in NIH research funding, lower volume growth, a lower provider tax and sequestration cuts, according to hospital CFO and vice president for finance Edward Chadwick. But clearly, the disruptions caused by the Epic install have been major.

S&P did show Wake Forest some mercy, changing its financial outlook from “negative” to “stable.”  The agency is predicting that the hospital should rebound financially in 2014 as the disruptive effect of the Epic install decreases.

November 7, 2013 I Written By

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.

EMRs Now A Patient Draw At Hospitals

In the past, the mere fact that a hospital had adopted an EMR wasn’t news in and of itself — at least not to a hospital’s current and potential patients. After all, hospitals didn’t let everyone know when they upgraded its network or added backup storage facilities, right?

These days, however, EMR adoption has become a consumer attraction, enough so that hospitals announce their go-live with press releases and public spectacle.

One example comes from Colorado Springs, CO-based Memorial Hospital, which is part of the University of Colorado Health system. Memorial, which launched its EMR this past weekend, spent $30 million on an Epic system.

The launch comes complete with a portal, My Health Connection, allowing  patients to access their medical records, request appointments online, communicate with doctors via secure e-mail and receive test results. The portal is also intended to make it easier for doctors throughout the UCHealth system to access patient records.

The Memorial press release announcing this milestone lumps the Epic implementation in with a laundry list of accomplishments aimed at selling consumers on the facility, including the hiring of 30 physicians, Chest Pain Center Accreditation with PCI and Primary Stroke Center Certification.

As this announcement points up, an EMR launch is seen as a consumer marketing win, not just another project completion by the IT department. Of course, that’s the case partly because the launch comes with the release of a portal offering convenient data access and appointment scheduling. But I’d argue that EMRs have grown sexy enough in consumers’ minds that the mere use of one has some cachet by itself.

Now, this marketing strategy can backfire if the EMR launch goes poorly. For example, I’m sure the C-suite execs at Sutter Health were dismayed when the nurses’ union there went public with safety concerns about the Epic EMR implemented across the system.

For the most part, though, I think we’ll see hospitals bragging about their new EMR if it offers any advantage to consumers. EMRs have become a prominent enough part of medical care that implementing one wins the institution some brownie points.

November 5, 2013 I Written By

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.

Embattled Hospital Relies On Epic To Help Acquisition

Here’s an interesting legal battle which puts a health system’s Epic EMR center stage.  Idaho-based St. Luke’s Health System, which is facing an antitrust challenge by a competing hospital, is responding to that challenge, in part, by citing the benefits of having an Epic system in place.

St. Luke’s was hit with an antitrust complaint lodged by Saint Alphonsus Medical Center, which claims that the system’s acquisition of Saltzer Medical Group of Nampa, Idaho will allow it to control nearly 80 percent of that market. The antitrust case, which involves both the FTC and the state of Idaho, is now before the U S District Court, reports EHR Intelligence.

During the proceedings last week, discussion focused on St. Luke’s decision to implement an Epic EMR, a move which reportedly cost $200 million. The install won’t be complete until 2017, according to the Idaho Statesman.

Though there’s a long road to walk before the Epic system will be complete, executives are already touting its benefits, with St. Luke’s CMIO testifying that Epic will allow patients to become engaged with their care, leading to better outcomes.

More importantly, for the purpose of the court  proceedings, adoption and implementation of the Epic system will eventually serve as the backbone of a St. Luke’s affiliate program under which independent doctors can use the system while paying only 15 percent of the costs, EHR Intelligence notes.

Saint Alphonsus Medical Center, for its part, argues that St. Luke’s reliance on the EMR is largely smoke and mirrors. In its joint pre-trial memorandum, the facility dismisses the claims regarding Epic’s benefits for Salzer as “speculative” and not a sufficient step to justify the acquisition. The memorandum also notes that Salzer already has its own EMR in place, making the purported benefits of substituting Epic even more tenuous.

So, what to make of this?  If nothing else, regardless of whether Epic contributes to the potential for this acquisition, the throwing down of the Epic gauntlet in court point to the prestige the vendor has achieved. Apparently, St. Luke’s feels that citing the availability of a system that won’t be fully implemented for five whole years is a workable defense given Epic’s high profile.

I find myself wondering whether a defense based on having another of the so-called “big 5″ EMRs would even be considered. Given Epic’s dominant position in the industry, it’s possible that it’s the only vendor whose name would do the trick.

October 28, 2013 I Written By

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.

Virtualization, Speech Recognition App Use Growing Among Hospitals

Virtualization software and dictation with speech recognition are likely to see increased uptake among hospitals in coming years, according to data from HIMSS Analytics.

The data, which is drawn from its Essentials of the U.S. Hospital Market, Autumn 2013 report, suggests that virtualization and dictation with speech recognition are top areas for growth potential, ahead of most other apps profiled in the report.

According to a HIMSS statement, these findings are consistent with other research the organization has done in the past which has suggested growing adoption of voice recognition-based transcription technologies.

The HIMSS report also concludes that demand for ambulatory EMRs and ambulatory PACS seems to be growing, according to the press release.

My colleague John Lynn and I had a huddle to discuss these results and while I see the growth in demand for voice recognition, he’s a bit more skeptical.  In  his view, voice recognition hasn’t changed much over the last couple of years, so it’s not clear to him whey there’d be an upsurge in demand now. Did Siri-like technologies make us more comfortable with voice recognition?

The only exception to this, he suggested, may be some integration deals that Nuance did with Cerner and Epic that might cause an increase in voice recognition adoption. However, this will only be mostly those who wanted voice recognition already as opposed to converting new people to voice recognition.

On my end, I’m a bit more bullish on voice recognition technology, at least if EMRs are capable of parsing the narrative into fields in the EMR.  I’m aware of some EMR vendors and some independent software vendors that are doing this or headed in that direction.

As for virtualization, John is a bit more excited about the future. After all, as he notes, there’s some cost savings and redundancy, plus fail over, that are nice benefits of virtualization. He’s also a fan of its disaster recovery and business continuity capabilities, in that if one server dies, you can roll a whole virtual machine over to another seamlessly.

As for me, I’d argue that any technical trend you see here could be changed abruptly as the EMR market shifts. Let’s see how the next Meaningful Use phase, and the further consolidation of the EMR sector, affects what’s hot and what’s not.

October 21, 2013 I Written By

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.

Partners Launches Major Data Integration Project

Partners HealthCare is launching a major data integration project which should bring it closer to its goal of implementing a single EMR across the entire Partners network over the next few years.

About a year ago, Partners announced that it would be integrating all electronic health information management into a single system that would serve the whole organization by 2017.

The Partners eCare initiative, massive by any standards, is the largest program of its kind in the history of the institution, Healthcare IT News reports. eCare’s mission is to enable systems that offer “one patient, one record, one team, one Partners statement.” eCare is ultimately intended to achieve some transformative goals, including redesigning patient care models and advancing population health management.

For this part of the project, partner InterSystems will replace several existing integration engines and enable the health system to consolidate its financial and clinical technologies into a single EMR platform, Healthcare IT News says. In doing so it will be working closely with Epic, Partners’ EMR vendor.

This is only the latest InterSystems deal for Partners, which uses the vendor’s Cache database for its existing EMR and hundreds of apps used by thousands of clinicians throughout its network, HIN notes. Partners also uses InterSystems’ Ensemble rapid integration software, which has enabled integration of its library of services and applications.

As this is going on, Partners’ division The Center for Connected Health is breaking ground on delivering new forms of patient care outside of standard medical settings. One experiment going on now is an effort in which Partners channels remotely-collected patient health data in its EMR. As of June, the Center’s remote monitoring database stored over 1.2 million patient vital signs.

With the Center working to change how and where care is delivered, and Partners corporate building an EMR capable (presumably) of making some use of this data, it’ll be interesting to see the end result. To date, EMRs have not been equipped to integrate remote monitoring data smoothly — but perhaps Partners will pull it off.

October 8, 2013 I Written By

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.

Stanford Uses Epic Feature To Conduct Web Visits

Stanford Hospital & Clinics has rolled out a new primary care service, powered by a feature available within its Epic EMR, offering medical visits via web video.

The new service allows patients to schedule video visits via the hospital website, using a scheduling application available on the site, InformationWeek reports. At the scheduled time, patient and doctor meet together in a web-based video conference.

The service, which Stanford dubs “eCare,” takes advantage of Epic’s software for video consultations. The video consult is integrated into the patient’s Epic medical record automatically. eCare also integrates third–party identity verification services in an effort to make sure the patient is who they say they are.

According to Stanford CIO Pravene Nath, M.D., who spoke with InformationWeek, video visits are medically appropriate for a range of noncritical visits and follow-ups. For example, one of the service’s first patients had an eye condition; the doctor was able to help simply by looking into the camera at the patient’s eyes. Another example of condition appropriate for web conferencing is treatment of a skin rash, Nath said.

“These are cases where a quick visual is all that is needed, followed by a quick interaction of the patient talking with the doctor,” Nath told InformationWeek.

Stanford is offering eCare first to employees of self insured firms who contract with the hospital. That way, neither the employer nor Stanford has to worry about whether a managed-care company will reimburse the doctors for the video visits. But Stanford’s intent is to make video consults available to everyone, InformationWeek says.

Stanford’s care program is just one of several virtual healthcare services the hospital’s developing, IW reports. The organization is also looking into secure messaging between doctors and patients and a service which involves submitting a still photo of them conducting a live videoconference, the magazine says.

If Stanford can make the integrated EMR and web visits work, it may be breaking new ground. A few months ago, I wrote a piece noting that many telemedicine providers are very reluctant to integrate with EMRs, given that the need for interoperability with so many systems could choke their development efforts.

While enabling telemedicine isn’t going to offer Epic any huge advantage it doesn’t have already, it does offer some intriguing possibilities. If thought leaders like Stanford make a success of web visits, using Epic technology, it might force other competitors into the telemedicine arena as well. It will be interesting to see how influential Stanford’s experiment turns out to be.

September 20, 2013 I Written By

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.

Greenway, Epic Systems Linked Together

These days, it doesn’t take a lot of data interoperability to make news.  The following, while a perfectly fine effort, concerns just one practice and one hospital, something which reminds us forcefully of how far we have to go. That being said, the details are worth a look.

Lancaster General Health’s Women & Babies Hospital, which runs an Epic EMR, has connected the Epic system with the Greenway EMR at obstetrics and gynecology practice May-Grant Associates. The two entities can now exchange continuity of care documents and securely share patient data, according to an article in Healthcare IT News.

According to Greenway, which issued a press release touting the development milestone, the architecture of its PrimeSUITE platform simplifies data exchange between disparate EMR systems, using a bidirectional, hub-based exchange built to support industry standards.  To connect the medical practice with the hospital, Epic needed to create a connection to the Greenway EMR which would enable data flow between the two entities.

The new interoperability between systems is expected to help coordinate care for more than 2,500 patients with the ob/gyn practice whose babies are delivered at the women’s hospital, Healthcare IT News reports.

Moreover, May-Grant expects shared data access to deliver financial benefits. According to the release, since the systems were connected May-Grant has seen improved practice management and revenue cycle management processes, especially when hospital patients are assigned to the practice for follow-up care.

“Now we’re able to get all of the details we need to process claims on behalf of those new patients,” said Mona S. Engle, RN, May·Grant practice administrator. “Since we can query the hospital for the information we need to submit with a claim, searching for that information no longer slows us down.”

As Healthcare IT News points out, Greenway is part of the new CommonWell interoperability alliance announced at HIMSS13 a few  months ago, but Epic is not.  So far, CommonWell members haven’t come out with any specific interoperability proposals of their own, so that probably didn’t matter this time around.

But it’s worth wondering whether CommonWell membership will make a difference going forward — and whether Epic’s non-participation will undercut hospitals’ ability to pull off projects like these. So far, the benefits of the Alliance seem distant and vague at best.

July 15, 2013 I Written By

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.

What If EMR Interoperability Was Mandatory?

For decades, industries have haggled and coded and bargained their way into shared data standards.  Each agreement has made great technical advances possible and grown markets into forms which could hardly have been imagined before.

Traditionally, the idea has been agreeing on interoperable standards is a form of enlightened self-interest.  The equasion “interoperability=larger markets=more pie for everyone” has nearly always managed to take root even in industries as brutally competitive as networking.  Consider where we’d be without 802.11 for WiFi, for example. If WiFi manufacturers had staged a prolonged battle over standards, and the reach of WiFi didn’t blossom everywhere, the Internet as we know it might not exist.

Well, here in EMR vendor land, we’ve somehow passed the exit marked “coopetition” and wandered off into interoperability nowhere land.  Sure, tell me about the CommonWell Alliance, which looks, on the surface, something like industry cooperation, and I’ll retort, “too little, too late.”  And do I even have to say that the idea that Epic supports everybody is something of a laughing matter?

Maybe, after seeing how miserably the EMR vendor industry has failed to come together to share data, it’s time to force the matter.  I read that ONC  honcho Farzad Mostashari has occasionally threatened to do just that, but hasn’t followed through with any proposed regs on the subject.

What if the FCC, the FDA and the ONC (which are now taking comments on a regulatory framework for health IT) decide to look at standards, pick a winner and shove it down the ever-living throat of every uncooperative vendor hoping to create dependency on their way of doing things?  That would include Epic, of course, which today, hears countless hospital CIOs say they had to buy their product because everybody else did.

Don’t get me wrong, this is a very, very serious matter; any regs that attempted to force interoperability would impose untold billions in costs on vendors, not to mention their customers. But if interoperability is the real prize we’re ultimately hoping to gain — the big EMR enchilada — is it possible that it’s time to take the risk anyway?  I don’t know, but I certainly wonder.  How about you, readers?

June 5, 2013 I Written By

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.

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.

May 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.