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Other EHR Options When Epic Denies You

Posted on January 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I got the following email from the CIO of a hospital.

They’ve [Quadramed] got the whole ONC-ATCB certified EHR for Phase 1 MU (although the point in your post is valid about that certification being fairly general anymore). They are working on obtaining and integrating/interfacing ambulatory functionality for physician practices, but for hospitals they have some pretty good sized hospitals running their QCPR product. KLAS includes them in their evaluation of EHR vendors (along with the likes of Allscripts, Cerner, Epic, GE, McKesson, Meditech, and Siemens) although they clearly don’t have as many installed hospitals that most of that list has. They also need to develop some real patient portal type of functionality to stay certified for future MU Phases. Not a market leader, but they are a market player. In spirit of full disclosure, we are almost live with Quadramed product, and we will be using it as a full EHR for both inpatient and outpatient care settings. We could not afford the bigger vendor solutions, and Epic wouldn’t even talk with us because we are below their minimum size to qualify for their sales efforts….only vendor I’ve seen that has that luxury of flat out ignoring possible business. We didn’t like the inflexibility of the lower end EHR vendors, and Quadramed provided a lot of the flexibility of bigger vendors for the price of the smaller vendors.

I’d love to learn where other hospital CIOs turn when Epic won’t give them the time of day. Considering Epic’s hospital size requirements and who they will work with, this is more hospitals than not. I started a list of hospital EMR and EHR vendors that might help. Where do hospital CIOs go when Epic isn’t an option? Is there a Denied by Epic support group somewhere online where hospital CIOs can commiserate?

Group Develops EMR-Less HIE Technology

Posted on August 22, 2012 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.

A pair of major tech players and a group led by Geisinger have come together to create tools making health information exchanges accessible to providers who don’t have an EMR in place. The tools are aimed at skilled nursing facilities, but from what I can see, the approach would work for other providers too.

Federal standards already require SNFs to submit MDSs — which are electronic patient assessments — to both the Medicare and Medicaid programs. The thing is, MDS data doesn’t conform to the Continuity of Care standard, so it can’t be shared amongst various providers across an HIE.

What’s happening is that Geisinger’s Keystone Beacon Community and GE-Microsoft joint venture Caradigm have created a MDS (minimum data set)-to-CCD transformer which turns patient care data into a Continuity of Care Document.  Providers can then take their CCD document and transfer it to  an HIE.

The Keystone Beacon Community, which is part of an HHS-backed program established in 2009, was launched to speed up the ability of health IT to transform local healthcare systems.  Keystone includes a network of 17 central Pennsylvania providers, including medical practices, hospitals, long-term care communities and others.

I’m not surprised to see Geisinger driving this train, as it’s been ahead of the EMR curve for many years. Geisinger is also large enough to conduct a real test of new technologies, as its network single-handedly serves more than 2.6 million residents of 42 area counties.

Still, I’ve got to wonder whether efforts like the Direct Project aren’t a better place to invest energy at the moment. It seems to me that Direct Project technologies are far simpler to deal with and still get a great deal done. But then again, maybe I’m just being a party pooper.  Nonetheless, I can’t help feeling that in this situation, less (complicated technology) is more.

Shouldn’t $1.2B Yammer Buyout Tell Us Something?

Posted on June 29, 2012 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.

Don’t know about y’all, but I’m a social media gal. I’ve used every system I could find for communicating in real time — including but not limited to Skype, Facebook, Twitter, Google Chat, AOL Instant Messenger, Meebo, Yahoo Instant Messenger and two cans with a string and attached keyboards.  It makes my work so much more efficient, I’m horrified I ever did without.

So, I guess I’m not terribly surprised that Microsoft put its official corporate seal of approval on the business uses of social networking technology with the purchase of business social networking firm Yammer.  The $1.2 billion in cash Microsoft paid for Yammer came as a bit of a surprise to this observer, but maybe I haven’t been paying close enough attention to the “social enterprise” space. Microsoft obviously has been.

Though this may be the biggest deal in the social enterprise space for some time to come, Microsoft isn’t the only company taking this tack. (For example, I know Salesforce.com is pitching the social enterprise take as well.) Let’s face it:  the time when socially-networked communication was just for fun has come and gone.

And that brings us right around to where we should be, taking another look at how EMR vendors are meeting — or failing to meet — the challenges of the times.

To my knowledge, no EMR vendor has yet incorporated even lightweight social networking tools like IM into their core functioning, despite the immense value such conversations can capture. I know EMR vendors have many, many weighty problems to address just in managing their basic functionality, but we’re not talking about black magic, people. Wouldn’t it make sense to offer new, easy to use, familiar teamwork tools to professionals in an industry that relies on life or death teamwork?

And the market has spoken. With one kajillion and three registered Facebook users out there, a near-Google of Twitter users and multiple millions of heavy LinkedIn users out there, it’s pretty clear that people count on social sharing to conduct their business lives as well as their work lives.

At this point, I think getting some robust social enterprise functions into EMRs is more than sensible.  Epic?  Cerner? GE?  Whaddya say?

P.S.  For some ideas on how all of this might work, check out this piece posted on KevinMD.com describing how social media and EMRs may someday merge.

Stalking the “Perfect” EMR

Posted on February 13, 2012 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.

Everyone’s heard about it, but nobody’s seen it — the perfect EMR. You know, the one that satisfies every doctor, integrates easily with every related hospital system, plays well with HIEs and even makes coffee for the CIO.

In all seriousness, virtually every EMR installation seems to involve systems integration problems, workflow requirements, user interface design or a  baker’s dozen of additional problems that hang like a cloud of smoke over even the more successful rollouts.

In theory, you might be able to resolve these disputes by letting the staff choose which EMR they’d like to see in place. But in reality, that doesn’t work either, argues John Halamka, MD, MS, whose many titles include CIO of Beth Israel Deaconess Medical Center and CIO at Harvard Medical School.  “I’ve heard from GE users who want Allscripts, eClinicalWorks users who want Epic, Allscripts users who want AthenaHealth, and NextGen users who want eClinicalWorks,” he notes.

Worse, if you let every department and clinical constituency pick what they want to include in their EMR, you end up with “an unintegrated melange of different products that make care standardization impossible,”  Dr. Halamka suggests.

As nice as it would be to satisfy everyone, there’s really only one approach that works, Dr. Halamka says. IT leaders need to pick an EMR for their enterprise that meets the enterprises overall strategic goals, one “providing the greatest good for the greatest number.”  Then, follow up with substantial training, education, collaboration, user engagement support and healthcare information exchange, he says.

No matter what your EMR turns out to be, it’s going to fix some workflow and process issues while creating others, he suggests. The best thing healthcare CIOs can do is simply go with smart enterprise-wide technology and help providers user it effectively.

This argument makes a lot of sense to me, at least at this stage in the emergence of EMRs. In, say, five years when key features are more standardized, it might be easier to buy “off the shelf” EMRs that please almost everyone. Or will it?  What do you think?

Another Instructive Hospital EMR Failure

Posted on January 30, 2012 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, I put out a call for people to share their stories of  EMR failures. As readers know, vendors trumpet their customers’ successes, but stories about mistakes and outright failures are hard to come by.

But this week I have one to offer, admittedly a bit in the past but still worth a look.  A LinkedIn reader just shared a story worth repeating in which a major academic medical center saw a hardcore fail of their EMR installation.  This the tale of how the University of California’s San Francisco seemingly dropped the ball during its Centricity installation.

Please note that I have no direct knowledge of what happened to UCSF during their implementation, which took place a few years ago. But according to blog Health Care Renewal , UCSF had to halt its $50 million rollout midstream, doubtless at huge cost, despite handholding from GE itself.

According to a news source quoted by the blog, insiders at UCSF were very unhappy with GE’s performance, suggesting that the giant vendor was far behind schedule in writing code.  At the time news reports were published, bigwigs at UCSF said they were evaluating their options and planned to plunge ahead in a few months.

If the news report was correct, this was more a vendor failure than an institutional problem. So what went wrong? The blog suggests that vendors like GE fail because they put management information systems grads in charge of projects, rather than those with deep medical informatics knowledge.

That being said, I find it difficult to believe that UCSF’s execs had no role in the failure. If its leaders had already committed to a $50M project, they clearly didn’t predict that GE wouldn’t be able to deliver. What’s more, my feeling is that they could have halted the project before it became a massive financial loss.  And worst of all, C-suite leaders almost certainly ignored negative staff feedback, which has to have been flowing long before the project hit the wall. (OK, that’s a SWAG, but isn’t it likely?)

Readers, do you think UCSF got its clock cleaned unfairly?  Or would you guess that leaders there ignore red flags until it was too late?  And if you were running such a project, what might you do differently?

P.S.  If you want to see some other EMR failure stories, check out this site, which is managed by blog contributor Dr. Scot Silverstein.

Unfortunately, Epic Seeing Growth Explosion

Posted on January 25, 2012 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.

Let me be candid here: I’m not too pleased with the progress of Epic as the hospital system of choice. Experience tells me that once a vendor becomes the default choice, seemingly due as much to C-suite peer pressure as technical merit, vendors get lazy and worse, extremely arrogant.

I admit most of us would be blinded by the magnitude of Epic’s success. According to chief administrative office Stephen Dickman, who spoke at a recent business luncheon in Madison, Epic’s stats include the following:

* It had 260 customers last year, and expects to add another 30 large customers this year

* It serves hospitals and clinics treating 33 percent to 44 percent of the U.S. population

* It has 5,225 employees and expects to add 1,000 this year

* It expects to have generated $1.2 billion in 2011 revenues

*  It has only five sales people on staff (!)

Sure, these numbers are very impressive. But that doesn’t excuse Epic’s imperial attitude, or CEO Judith Faulkner’s contention that hospitals should only worry about interoperating with her company’s products. Look, Ms. Faulkner: I’m sure you’re bright, but I’m pretty sure you’re no Steve Jobs. You may be taking over the hospital EMR business, but you’re not reinventing it.

In my experience, users uniformly say that Epic’s interface is all but broken, that it’s hard to adapt and in some cases, that the 20-something young geniuses the company sends to install and service its systems aren’t particularly deferential. (If you want to hear a particularly galling tale — downright terrifying, if true — check out the tale of one engagement in which Epic staffers seemingly tried to get a hospital CIO fired.)

Meanwhile, if Epic leaders ever gave a damn about building great products, they don’t have a lot of incentive to do that now. Yes, they face well-financed competition from Cerner and Meditech and GE, but if they only have five sales people on board, they must assume they can beat those folks with one hand tied behind their back.  At this point, in other words, competition isn’t enough reason to keep improving their product.

I guess the bottom line here is that I instinctively distrust any company that seems too secure at the top, especially if they’re not known for being especially likeable or having a superior product. Isn’t anyone going to show up and challenge them for the throne?

Hospital EMR Vendors Making Serious Play For Doctors

Posted on September 19, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

When you think about how big-iron EMR vendors like McKesson, Cerner and GE operate, it’s hard to imagine them serving small medical practices.  These guys, and their sales teams, are used to making the big sell to hospitals — and making the big bucks on very large installations.

This week at the American Academy of Family Practitioners show, though, McKesson, Cerner and GE were all pushing physician-oriented products:

* McKesson was launching its Practice Partner system, a Web-based EMR and practice management system. The giant vendor is also offering doctors help in building a patient-centered medical home, working in partnership with the AAFP’s TransforMED subsidiary.

* GE was promoting its Centricity Advance, an Web-based, integrated EMR, practice management and patient portal platform which can be “implemented in 30 days,” the vendor notes. (Somehow, I don’t think this will sound fast to doctors.)

* Cerner was flogging its Ambulatory EMR/EHR, which comes in ASP, remote-hosted and client-hosted flavors.  Unlike its competitors, Cerner’s sales pitch included claims based on specific results, including, interestingly, an assertion that users were spending up to two hours less time per day on paperwork.

Conspicuous by its absence — to my mind at least — was hospital EMR giant Epic. Epic does offer an ambulatory EMR, which shares its database with the EpicCare Inpatient Clinical System. But apparently it didn’t feel the need to pitch to AAFP members, despite their being leaders in their field who are likely to influence many peers in their EMR buys.

I suppose this squares with Epic’s style overall, as the company doesn’t seem to do much high-intensity selling these days.  In all honesty, they don’t really have to do any, either.

On the other hand, doctors don’t seem to have any love for Epic (I can’t count the number of times I’ve heard a physician stand  up at a conference or seminar to complain that it’s barely usable), and if Epic wants to reach physicians with an ambulatory product it’s got fences to mend.

In any event, hospital IT folks, it’s worth noting that the vendors making your shortlist are reaching out to doctors. Maybe, just maybe, this will make it easier to bring them on board sometime soon. Guess we’ll have to see how that plays out.

Hospital EMR Apps Hitting The Market

Posted on September 9, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Adding a iPad-friendly front end to EMR apps is a brain-dead obvious move — but vendors move at their own pace. Thus it is that enterprise EMR vendors are just getting around to kicking out front-end apps for their systems, a year or more after the iPad landslide hit medicine.
Perhaps the most recent vendor to develop an EMR app is SAP, which plans to make one commercially available by late October, according to mobihealthnews. The SAP app will be piloted by three European hospitals. (Check out a lovely screenshot of the EMR app, buried in the center of a ZDnet story.)

SAP’s app will do all the expected tricks, including access to patient data, med history, allergies and radiology images. It will also offer a real-time view of patient vital signs, something I’d argue every EMR app should provide.

At least two other major vendors have also gotten into the iApps game. A few weeks ago, for example, GE launched a front-end app for its Centricity Advance EMR, which serves practices with less than 10 physicians.

At the front of the line, surprisingly, was Epic, which released its iPad app Canto just over a year ago. To create Canto, Epic redesigned its iPhone EMR app Haiku and redesigned it for iPad use. I say “surprisingly” because as most readers know, Epic isn’t known for being fashionably current in its technology. (The MUMPS/Cache database at its heart is a dead giveaway.)

Not to sound too slavishly pro-Apple, but as I see it, there’s little excuse for major EMR vendors to avoid the iPhone/iPad platform.  The iPhone is at least as popular among doctors as it is among the general population, and the iPad is increasingly becoming important in the practice of medicine.

Let’s hope we see the other enterprise EMRs snap to and roll out apps pronto.

Did Epic Kiss Off A California Customer (And Try to Get Its CIO Fired)?

Posted on August 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

If Cerner, Siemens, GE, McKesson or Allscripts have ever tried the following, I’ve never heard about it. So before you complain that we’re turning this site into the “I Hate Epic Weekly,” consider the following. You tell me whether things are getting strange at Epic, at least if the following is true.

So, your editor was quietly, non-aggressively, not shotgunning for any vendor anywhere when I reviewed the search logs for this site yesterday. As I scanned the list of terms, I find “epic dumps california hospital” on the list.  Hmmm, I tell myself, maybe there’s a contract dispute involved? Why else would there be a nasty breakup? Why else would a vendor turn down a multi-million dollar contract?

Here, I’m going to do something I rarely do, which is to quote a large section of a post from the justifiably famous HIStalk.com rumor mill:

From Mavrikg41“Re: Epic. [hospital name omitted] was rejected by Epic in the evaluation process because Epic thought [CIO name omitted] was ‘going to get in the way of the success of the implementation.’ They called that out in the report to the hospital’s executives as to why Epic would not be a good fit at [hospital name omitted].”

Mr. HIStalk, who calls the rumor “unverified,” nonetheless seems pretty exercised — and seems to think the story may be true. His words:  “It’s a vendor low blow to call out an hospital executive by name to his or her peers as an excuse for turning down their dozens of millions of dollars. Unless Epic is trying to get the CIO fired, why not just politely decline the business without naming names?”

And more from Mr. HIStalk: “Once the Epic train gets rolling in a given hospital, you don’t want to get in front of it since frontline executives seem happy let Epic 20-somethings tell them how to run their business (especially the IT part) instead of listening to their own vastly more experienced people.

I wish I thought this story was unlikely, but I don’t. It just makes too much sense. Senior execs are scared out of their wits by new technology, and doubtless prefer buying their advice from the Dogbert Consulting Company, i.e. Epic’s army of occupation.

By the way, if you look at employee stories from inside Epic , it becomes pretty clear who that hospital CIO was dealing with — mind-bogglingly competitive, relentless Type-A personalities, often proving themselves on their first real career assignment, inspired to push through bruising 70-hour workweeks by convincing themselves that they’re masters of the universe. Sound familiar?