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Allscripts Loses NYC Hospital Deal To Epic, Files Complaint

Usually, battles over a hospital EMR contract fall below the radar, with only the hospital and vendors the wiser as to what took place during negotiations. But this time, we may be treated to the spectacle of seeing a large health system explain, in some detail, why it chose one vendor over another.

Allscripts, which lost an EMR contract for New York City’s public hospital system, is crying foul over the system’s decision to go with Epic.  Allscripts has filed a complaint over the award of the $303 million contract, which involves tying together 11 public hospitals, 70 clinics, thousands of doctors and more than one million patients, The New York Times reports.

Allscripts estimates that over 15 years, when ancillary costs are included, it would cost $1.4 billion to implement Epic, while its own EMR rollout could be completed for less than half that number.

Right now, the contract is on hold, and won’t be in force until Allscripts’ complaint with a procurement-review board within the city’s Health and Hospitals Corporation is resolved. (HHC runs the public hospital system.)

But Alan Aviles, president of the corporation, doesn’t seem like he’s willing to budge. Aviles told the Times that HHC chose Epic after considering nine vendors over four years. And he argues that Allscripts’ recent management and financial troubles only validate HHC’s decision.

And at the end of the day, Aviles simply doesn’t buy Allscripts’ estimates. “Allscripts and its CEO absolutely know that the $700 million [savings] number they tossed out is fallacious,” Aviles said. What’s wrong with their numbers? Well, for one thing, Aviles says, Allscripts estimated that the application-support team needed to implement the EMR would cost nothing over 15 years, while HHC had calculated that 15-year staff support would cost $357 million.

Readers, I don’t know about you, but I think there’s some degree of truth on both sides.  If Allscripts submitted a proposal assuming no support costs for HHC, they must be out of their minds.  At the same time, though, I’ve never heard of a major Epic installation being anything but the most expensive option, bar none. Seems to me the truth lies somewhere in the middle.

October 11, 2012 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.

The Dawn Of “Compliance As A Service”?

A few days ago, I posted a quick report on our EMRandHIPAA.com sister site discussing Verizon’s plans to offer a HIPAA-compliant cloud service.

Verizon, which has beefed up on security services over the past few years, seems to see its role as being compliance vendor rather than just a mere business associate.  The carrier notes that not only does it offer super-secure data centers, it has trained staffers on HIPAA-specific data handling issues.

But Verizon obviously isn’t the only cloud vendor out there capable of offering HIPAA-compliant services. Could this be the dawn of CaaS (compliance as a service) for healthcare? (Others industries, like banking, are already well into this approach.)

According to reader Scott Gardner, who commented on the story, this concept has legs. “I’ve been pitching [Compliance As A Service] to cloud-based persistency vendors targeting mobility for some time,” writes Gardner, whose company Inyago focuses on private practice IT services via MacPractice. “Offering this service makes perfect sense, especially in private practice healthcare. And you get interoperability (core #14) right out of the box for all users on the platform.”

The burning question here, I suppose, is whether CIOs feel safe trusting outsiders with clinical data flow. Right now the answer seems to be “no.” As my colleague John noted in a related blog post, at present even those providers who are cloud users are more prone to access it for “commodity” services such as e-mail, file storage, videoconferencing and online learning, according to a CDW survey.

With providers needing interoperability under Meaningful Use Stage 2, the landscape may change, however. Whether or not they’re terribly comfortable with Verizon and its rivals, CIOs might find it easier to delegate compliance than cope with the difficulties of build-your-own-interoperability schemes. So perhaps CaaS really does have a chance at achieving rapid uptake — unless someone invents the insta-install HIE!

October 5, 2012 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.

Feds Claim Hospitals Are Using EMRs For Upcoding

Geez, you can’t win for losing these days. First the feds put enormous pressure on hospitals to near-bankrupt themselves buying sophisticated EMRs and meet Meaningful Use standards.  Now, as a piece in The New York Times notes, the feds are going after hospitals which are allegedly using EMRs to upcode Medicare and Medicaid claims.

As my colleague John notes, the key finding that The New York Times article discusses is that Medicare costs have gone up substantially for those using an EHR. This has the feds’ knickers in a twist. The administration now plans to look aggressively for providers who are committing coding fraud, while also considering whether it needs to change the way it pays for care.

In a letter signed by U.S. Attorney General Eric Holder Jr. and HHS secretary Kathleen Sebelius, the Obama administration said that their are “troubling indications” of abuse in how hospitals are using EMRs to bill for services.

The letter, which went out to five major hospital trade associations, warned that it was aware of abuses such as “cloning” of medical records — in which information on one patient is repeated in other records to inflate reimbursement. CMS has also gotten reports that hospitals are upcoding the intensity of care or severity of a patient’s condition.

The American Hospital Association, for its part, says the problem is partly on CMS’s own shoulders. As it noted in a letter responding to the administration, hospitals have been using CPT and E/M codes to report utilization at clinics and emergency departments.  The AHA has asked CMS to implement a set of national hospital E/M visits developed by an independent expert panel, but to date, CMS has neither implemented those guidelines nor proposed its own, the association says.

You know what? I think the AHA has a very good point. Unless CMS issues a single national standard for reporting such visits, coding is going to all over the place. That’s just reality.

Meanwhile, as to whether hospitals are trying to put the squeeze on CMS by fraudulently upcoding, it’s anyone’s guess, but my theory is that hospitals are merely doing a better job of capturing what they’re already doing . So while I appreciate the need for CMS to be vigilant, they might want to do some studies before they accuse hospitals of criminal misbehavior.

September 26, 2012 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.

Health Management Associates Makes System-Wide Deal With athenahealth

Cloud-based EMR vendor Athenahealth has struck a deal with hospital chain Health Management Associates that its vendor competitors would die for.

HMA has signed an agreement with athena under which the chain’s 1200+ employed physicians — cutting across 15 states and 300 locations — will now use the vendor’s practice management, EMR and patient communication services. HMA’s 10,000-odd independent physicians will also have access to the systems.

In the announcement, HMA and athena took pains to emphasize that the selection process was a fair and thorough one:

Health Management selected athenahealth after a twelve-month review and due diligence process that involved more than 350 clinical experts, including more than 200 physicians. The evaluation process included detailed questionnaires, onsite and virtual demonstrations, site visits, and clinical template shootouts.

Perhaps those details were included to convince observers that the deal didn’t include some kind of payola. I don’t think doctors are going to be too impressed by the IT talk. (If it were me I’d care about only one demonstration — how it worked for me on Day One.)

HMA may not be the country’s largest hospital chain, but it’s still a heavyweight, operating 66 hospitals spanning 10,330 licensed beds. Its hospitals span Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Washington, and West Virginia.

Particularly given its scale, this deal intrigues me for a few reasons. It raises what seem to me to be important questions:

* Is HMA expecting its independent physicians to dump whatever EMR they may already have in place and switch it out for athena?  Or adopt its practice management module instead of what they use now?  That seems, uh, a bit unrealistic?

* I don’t know what enterprise EMR system HMA uses (do you, readers?) but whatever it is, I doubt it will plug seamlessly into to the athena cloud.  How do the IT types at HMA plan to connect the whole schlemiel?

* If the independent physicians don’t want to adopt the athena package, what will HMA do? Club them like baby seals?  Or just accept that a large percentage of its docs aren’t connected?

September 21, 2012 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.

CA Doctors Say Epic Install Is Creating Massive Turmoil

Not long ago, Contra Costa County, California spent $45 million on an Epic Systems installation designed to tie different sectors of the county health system together. The implementation, which the county dubbed “ccLink” went live on July 1st. The tale that follows here is all second hand, taken from a great piece in an area newspaper, but it’s quite believable, as you’ll see.

To wit, emergency department waits at the county’s hospitals have shot up, with one in 10 patients leaving without being seen due to the backlog.  One patient waited 40 hours to get a bed, according to Dr. Brenda Reilly, who spoke to county board of supervisors earlier this week on behalf of doctors working in county facilities.

In addition to live testimony, 15 doctors co-signed a letter to the board pleading for hospital administrators to cut back on physician workload further — some cuts have already been made — as physicians feel they’re unable to keep up and provide adequate care under the circumstances.

“We were not ready for Epic and Epic was not ready for us,” pediatrician Dr. Keith White told the board, according a report in the Contra Costa Times.  ”As a result, the providers are struggling to provide safe and effective care…many doctors have left and all are considering leaving.”

This week’s protests follow earlier complaints in August, when nurses at the county’s detention facilities told supervisors that ccLink was jeopardizing patient safety due to the rapid install of the system.

Dr. William Walker, the county’s health services director, told the audience at the hearing that he plans to create teams of medical care providers formed to make the doctors’ paperwork trials easier.

As things stood, however, doctors weren’t mollified, calling ccLink “clunky and time-consuming, designed more for bureaucrats than physicians,” the paper reports.

Given their Epic obstacles, which have seemingly slowed medical care to a crawl, doctors are seeing half or fewer of the patients they’d been seeing.

With those patients seemingly spilling over to the emergency department, the average time a patient spends waiting in the county hospital EDs has gone from three to four hours, arguably as a result of the Epic install issues. It’s hard to argue that the new EMR is at least partly responsible for the logjam.

To be fair, I’ve heard of many an EMR installation which created temporary havoc and pumped up wait times in the ED for a while. But the level of paralysis I’m reading about hear seems to be setting some kind of record.

P.S.  A side note: I called the nice young man who wrote the story to give him a backgrounder on Epic and some of the interoperability and just plain functionality problems I’ve gotten wind of elsewhere.  He told me he’d gotten tons of calls already! Seems the Epic critics/watchers have their teeth into this one.

September 20, 2012 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.

Hospitals Plan HIE Spending Binge, But Are They Prepared?

Here’s some stats that wowed me, and may surprise you too. It looks like hospitals, under pressure to move towards meeting Meaningful Use Stage 2 expectations, are finally barreling into investments in HIE technology.

According to a new study by CapSite, 71 percent of hospitals  surveyed plan to purchase new HIE technology, and 50 percent have joined a private, state or regional HIE. The CapSite 2012 U.S. Health Information Exchange Study, which surveyed about 370 hospitals on their plans, noted that these stats show an uptick from 2011, where they found that one-third of hospitals had joined an HIE.

Why do these stats seem remarkable to me?  Well, for one thing, they’re spending a lot of money to do something nobody seems to know how to do well. To quote a previous story for this blog:

The question is, and has been for many years, whether those investments offer any financial or clinical payback. After all, you can only lay out that kind of money for so long before there’s no business case for the exchange.

Unfortunately, it looks  like the answer may still be “no” in many cases, according to the authors of a study appearing in Perspectives in Health Information Management. Of the 96 HIEs that responded to the researchers’ survey, the “vast majority” didn’t have a business model in place that would sustain itself even into the near future.

It’s not that there aren’t roadmaps for hospital HIE builders to consider. Earlier this year, for example, the National eHealth Collaborative and IDC Health Insights released reports offering best practices HIE builders should consider.

But if you look closely at these recommendations, as well as others made by analysts and policy makers, it appears the HIEs are going to have to get past lots of political obstacles. The NeHC’s step one, “reaching a consensus with regard to objectives and vision for the exchange” could be a real trial in and of itself.  Getting to the point where hospitals share governance effectively with other bodies, deal with competitive issues and handle interoperability — well, I’m not going to hold my breath.

So, while HIE fans (and vendors, natch) are likely to be cheered by this report, I’m calling this out as a potential disaster. Hospitals, are you really ready to spend HIE money wisely?

September 17, 2012 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.

Specialty EMRs: Behind The Curve?

While I’m not an academic type, a lot of research passes over my desk. That includes both anecdotes and statistics on specialty EMR adoption. From what I’ve seen, the arguments for and against specialists using specialty-specific EMRs are more or less in a dead heat.

For that reason, I was particularly interested to read this quote in a recent article on specialty EMR adoption, which cited factors why specialists supposedly aren’t buying in to practice-specific solutions:

“One, most specialists are already invested in standard solutions. Two, most specialists would not consider such applications as mature products. After all there are specialties within specialties, and then every specialty has their own way of operation. Three, specialist workflow is too intricate for extensive automation.”

I think each of these assertions are worth addressing. Taken as a whole, they suggest that specialty EMRs are way behind the curve, I think, and that’s a pretty significant claim.

First, are most specialists really invested overwhelmingly in standard solutions? This could be true but I wasn’t able to dig up evidence to support this claim.  Specialists may be using hospital-based systems, which by default puts them on a broad-based platform, but that’s another discussion entirely.

Looking at point two, are specialists looking at, say, a cardiology or ENT-specific EMR as immature by definition?  Again, I’m not sure what to make of this. I don’t have data immediately to hand, but it does seem to me that some specialties have pretty mature EMRs available to them, while others may not.  (As for the observation that ‘every specialty has its own way of operation,’ well, that’s true, but isn’t that true of primary care practices too?)

Third, we have the claim that specialist workflow is too intricate to be automated. I’m particularly skeptical of this one. It’s certainly legitimate to question whether subspecialty workflow is currently being automated well, or whether such EMRs offer flexible enough tools to allow for customization, but flat-out suggesting that it can’t be automated strikes me as fishy.

Bottom line, my instinct is that specialty EMRs have as good a chance as any to serve as a useful tool.  Arguing, in essence, that they just can’t be done right doesn’t make a lot of sense to me.

September 14, 2012 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.

#EPICUGM 2012 Offers Tantalizing Hints

This week Epic held its annual user group meeting (#UCG2012 or #EPICUCG), complete with a full-stage Journey tribute, Wayne and Garth and tantalizing promises of neat features to come.

Because we weren’t at the conference, we took a dive into the tweetstream to see what some of the highlights were.

A big crowd

Attendance at the event was enormous, even by the standards of jaded little me:

Funny business

The event kickoff included a tribute to Journey’s “Don’t Stop Believing,” presumably performed by Epic’s multitalented staffers. I liked the Wayne’s World kicker at the end, as did the audience, which seemed to do a lot of un-IT-like giggling.

Happy smiling people

If the tweets are any indication, a fair number of attendees found #UCG2012 to be something of a rush:

Fascinating factoids

Along the way, attendees did some of Epic’s PR on their own, tweeting such facts as:

And there was this interesting note on the relationship between advanced EMR deployment and being an Epic customer:

Features afoot

All of the enthusiasm was fine. I get it: Rah rah rah Yay Epic! But on to some meatier stuff. Apparently some interesting new features are on the way:

 

 

Sadly, though, on the subject of interoperability, no Original Thoughts seemed to be under discussion:

Maybe the whole “walled garden” thing will be fixed by, oh, UCG2020?

September 13, 2012 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 Won’t Happen In #HIT By September 2013

As part of the upcoming National Health IT Week (#NHITWeek), which takes place September 10 through 14th) my august colleague John has written up a list of ways in #HIT is likely to make a difference over the next 12 months.  (He makes some great guesses; definitely give the post a look.)

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?”  Here’s some of my predictions:

* EMR-to-EMR interoperability:  Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

High penetration by HIEs:  With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

Major uptick in open-source HIT  use:  Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

Epic controls the hospital EMR world for good:  Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak.  But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring:  Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs.  I just think we’re going to remain stuck with some of these legacy issues for some time to come.

September 7, 2012 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.

Are Best Of Breed EMRs Going Out Of Fashion?

This week, I visited a hospital which belonged to a health system going with Epic. This hospital, one of the smaller facilities in the chain, was running Picis in the ED and (I think) Cerner throughout, but the decision had been made to convert everything to Epic sometime soon, a tech told me.

I can’t say the news was surprising, but it was disappointing nonetheless. The community hospital in question has given me excellent service, and my guess is that when Epic barrels in, it will lose its way — at least for a while — frazzling the staff and decreasing the quality of their interaction with me.

However, I ‘d better get used to this trend. As Healthcare Technology Online editor in chief Ken Congdon notes in an excellent editorial, the pendulum is definitely swinging toward enterprise-wide EMR implementations, a direction encouraged by the standardized demands imposed nationwide by Meaningful Use.

If interoperability was easier to pull off, things might be different. But with HL7 and other integration standards and languages still not quite up to the job, one can see the sense of going with an enterprise option.

Here’s the story one CIO told Congdon as to why he’s deploying Siemens Soarian solution:

Michael Mistretta, CIO of MedCentral Health System  [said:]  “Vendor management was a key consideration in our decision to use a single vendor approach to EMR implementation,” says Mistretta. “With a single vendor, I only have one finger to point at. It simplifies my environment because I don’t have Siemens telling me it’s McKesson’s problem and vice versa. Also, the built-in interoperability is key. There is a trade-off in the fact that the system does not provide prime functionality to certain departments or specialties within our health system, but at this point in time, it’s much more beneficial for our organization to have the ability to share data across the continuum of care quickly and easily.” 

CIOs of large hospitals also told Congdon that enterprise system replacements were much cheaper than going through a long-term, highly-complex integration effort.

In an interesting twist, however, hospital IT leaders from mid-sized to smaller hospitals have reached the opposite conclusion, Congdon reports. They’ve been telling him that buying an enterprise system would be much more expensive than sticking with what they had and making it interoperate.

I see a market opening here. If enterprise EMR vendors can get their pricing in line for smaller hospitals, they may have a lot more wins coming their way than they expected.  Interesting stuff.

September 4, 2012 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.