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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.

Hospital Partnerships May Help With EMR Costs

Posted on October 29, 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.

Nearly three quarters of hospitals surveyed in a recent study by health IT vendor Anthelio plan to find partnerships while retaining ultimate ownership of their facility. And among the to-do list items more than half need to pull off is implementing their EMR.

The survey, which was conducted between August and September 2013, used an e-mail questionnaire which was sent out to community-based hospitals and health systems with up to 500 beds, according to a report in Health Data Management magazine. The researchers received responses from 135 community hospital executive representing 123 community-based hospitals.

Seventy-four percent of respondents were looking for partnerships that didn’t involve giving up their independence, while only 9 percent were considering consolidation with a hospital system. That’s a huge dip from last year, in which 41 percent were willing to consider consolidation.

Of the group, only 40 percent have completed and are operating EMRs. Most of the remaining 60 percent have bought an EMR, but have only partially implemented it. It seems very likely that those who haven’t finished their implementation are hoping to leverage their partners’ IT resources to get the job done more quickly and effectively.

Of course, there are other expensive items on hospital executives’ plates, including the transition to ICD-10. Researchers found that 39 percent of respondents have spent or anticipate spending less than $100,000 on the ICD-10 transition, 40 percent will spend $100,000 to $499,000, 13 percent will spend $500,000 to $999,000 and 9 percent will spend more than one million, Health Data Management said.

Take these two forces alone, and it’s clear why hospitals are willing to give up some of their independence in exchange for financial and operational support from a partner. Toss in the need to have a decent bargaining position in a post-ACO world, and the idea of partnering up looks even more attractive.

Still, it’s a risky strategy. To be honest, I’m skeptical that a partnership can deliver these benefits the way executives would hope. In fact, my guess is that a partnership or merger would make an EMR implementation more difficult to coordinate, not less. I suppose we’ll have to wait and see what actually happens.

Hospital Vs. Clinic EMRs: Key Differences

Posted on May 14, 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.

In some ways, hospital and clinic EMRs have the same job to get done — to assess, test and treat patients. But they do have to be optimized differently, as hospitals and clinics do things at a different pace and of necessity are organized differently.

Here’s some of those differences, courtesy of TELUS Health’s Shawn Vincent:

*  Difference number one:  Minutes count

Hospitals care for patients in acute situations, where minutes or even seconds can determine the patient’s outcome.  In medical practices, “care is measured in weeks, not hours,” Vincent notes.

Result:  Hospitals need test results immediately, where clinic patients can wait until their next visit days or weeks later.

* Difference number two:  Patient departures

In hospitals, patients consume resources until discharge, and that doesn’t happen when tests and treatments are still outstanding.  In clinics, patients can leave while tests are outstanding or treatment results are still pending.

Result:  Hospitals must perform well at “round trip” test and treatment management.

* Difference number three: Who runs the show?

Hospitals are generally run by a large corps of professional leaders, including boards of directors, business expects, lawyers and many other stakeholders.  Medical practices, traditionally, owned by doctors who practice there, and are responsible for care, documentation, and ultimately, liability for all that takes place.

Result:  Hospitals usually have tough rules in place about how medicine can be practiced, and also how it is documented, which roll down to everything from how the EMR user interface looks to how events are audited. In clinics, doctors make their own rules.

* Difference number four: Short vs. long-Term Care

Hospital encounters usually call for just enough information to treat the patient — more can be a distraction which slows down care.  In medical practices, on the other hand,  having longitudinal data on the patient is central to caring for them over the years.

Result:  Hospital IT systems must be artfully designed to display “just enough information to make a meaningful medical decision without distracting the user with unnecessary details,” he notes.

Readers, what other differences between hospital and medical practice EMRs do you consider to be important?

Contest Offers Prizes For CCD Redesign

Posted on November 19, 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.

When EMRs are the gossip of the week at TechCrunch (a popular tech startup website), you know our little EMR thang has gone mainstream. And TechCrunch is indeed one of a series of sites trumpeting the news of a design challenge intended to make the Continuity of Care Document more usable.

The White House’s Health Design Challenge, working with a community of philanthropic angels and mentors known as Designer Fund, asks designers to transform the CCD (and by extension the Blue Button output) from a consumer-hostile mess into something easily used by the following groups:

  • An underserved inner-city parent with lower health literacy
  • A senior citizen that has a hard time reading
  • A young adult who is engaged with technology and mobile devices
  • An adult whose first language is not English
  • A patient with breast cancer receiving care from multiple providers
  • A busy mom managing her kids’ health and helping her aging parents

The ONC and VA, which seem to be spearheading the effort, are providing for twelve winners. First place for best overall design gets $16K, second place $6K and third place $4K. They’re also distributing $8K per category across winners for best medical/problem history section, best medication section and best lab summaries.

The design is expected to not only improve the visual layout of the record, it’s also supposed to make it easier for a patient to manage their health, enable medical professionals to digest information more efficiently and help caregivers support patients. Tall order for a messed-up text file?  Well, we’ll see what design superbrains can do.

In part because the VA hopes to use the new designs to support its Blue Button initiative and its MyHealtheVet patient portal, all entries have to be submitted under a Creative Commons license.   Curators will select a final design — which may include elements from various winning entries — and open source the code on code-sharing commuity Github.

What HIMSS Told Congress

Posted on November 16, 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.

This week, a House subcommittee held a hearing entitled “Is ‘Meaningful Use’ Delivering Meaningful Results?: An Examination of Health  Information Technology Standards and Interoperability.”  The hearing follows a recent furor over Meaningful Use’s benefits, in which HHS head Kathleen Sebelius was written a stinging letter by a quartet of Congressman arguing that the program might not be pulling its weight.

Lots of interesting discussion took place at the hearing — see a report from the indefatigable HIT blogger and expert Brian Ahier for more background — but for the purposes of this item, I’m focusing on what HIMSS had to say.

HIMSS, which obviously has a massive stake in the topic discussed, is a big Meaningful Use fan. The trade group argues that “Meaningful Use and the Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.”

Not surprisingly, HIMSS showed up in full color at the hearing, ready to defend MU and the progress of health IT generally. HIMSS offered Congress seven recommendations as to how to keep the MU train moving, Ahier reports. Here’s my favorites:

  1. Direct the administration to initiate an appropriate study of a nationwide patient data matching strategy with a report back to Congress.
  2. Support harmonization of federal and state privacy laws and regulations to encourage the exchange of health information across health systems, payers, and vendor systems.
  3. Continue to support and sponsor pilot programs addressing the collection, analysis and management of clinical data for quality reporting purposes to assist providers and provider organizations make informed decisions for public health, patient care and business purposes.
  4. Preclude any additional delay in the nationwide implementation of ICD-10, International Classification of Diseases beyond the current October 1, 2014 deadline.

Other than the ICD-10 recommendation, which will probably be battled down to the last millisecond by some groups, I’m betting most readers would consider these to be reasonable steps. But I could be wrong. And I don’t see a lot here on the nitty-gritty of interoperability, which was the focus of the Congressmen’s ire in the first  place.  Folks, what would you add to/subtract from this list?

Gap Between Small/Rural and Large/Urban Hospitals Closing

Posted on November 7, 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.

As readers know, we’ve been tracking the progress of Meaningful Use uptake, and data has repeatedly suggested that small and rural hospitals were lagging behind. Now, courtesy of Modern Healthcare, comes an analysis suggesting that the EMR gap between small/rural and large/urban hospitals may be closing.

The magazine, which drew this conclusion after analyzing a CMS/ONC database of meaningful users of EMR systems, found that small hospital-oriented vendor CPSI has moved to the number one position among vendors “whose hospital clients have achieved Meaningful Use with systems certified as ‘complete EHRs.’ ”

According to Modern Healthcare’s analysis, CPSI’s 266 hospital clients account for 19 percent of the 1,381 hospitals that have become meaningful users with complete EMRs.

CPSI, which typically serves hospitals of 100 beds or less, can now boast more hospitals with so-called complete EMRs than larger vendors like Epic and Meditech.  Epic has 251 clients which met Meaningful Use criteria for a complete EMR, and Meditech came in third with 173 hospital clients who were meaningful users of complete EMRs.

That being said, this doesn’t mean that the small and rural hospitals don’t face significant barriers when it comes to acquiring — and more significantly, developing sophisticated uses for — robust EMRs.

As the Modern Healthcare piece notes, far more large hospitals adopted an EMR in 2011 (25.4 percent) than did small hospitals (14.7 percent).  There was also a big gap between the percentage of rural hospitals who adopted EMRs (19.4 percent) versus urban hospitals (19.1 percent), according to Mathematica Policy Research.

It’s also worth noting that when last we checked, smaller hospitals were generally far lower on the HIMSS EMR Adoption Model scale.  Smaller hospitals and rural facilities were on average below 2 on the seven point scale, while urban and academic institutions scored much higher.

That being said, I like how Modern Healthcare used vendor data as a proxy for looking at the status of small/rural hospital EMR adoption. Good idea. Any data we have on how hospitals are faring is good data.

UPMC Sinks $100MM Into Big Data

Posted on November 6, 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.

The University of Pittsburgh Medical Center has announced plans to spend $100 million over five years to create a massive data warehouse, a move which puts it well at the forefront of hospital “big data” efforts.

According to Information Week, UPMC’s data warehouse will bring together clinical, financial, administrative, genomic  and other information. The health system has targeted more than 200 data sources across the Medical Center, UPMC Health Plan and other affiliates.

I’ll let Information Week describe the technical set-up:

To collect, store, manage, and analyze the information maintained in the data warehouse, UPMC will use the Oracle Exadata Database Machine, a high-performance database platform; IBM’s Cognos software for business intelligence and financial management; Informatica’s data integration platform; and dbMotion’s SOA-based interoperability platform that integrates patient records from healthcare organizations and health information exchanges. These tools will manage the 3.2 petabytes of data that flows across UPMC’s business divisions.

As to how UPMC plans to use these tools, they’re hoping to do all of the things you might imagine, including genomically-tailored prescribing, population analytics and sophisticated tracking of individual patient data to make predictions about possible risks.

As I see it, UPMC’s efforts highlight both the importance of big data efforts and the downside in making the investment.

On the one hand, you’ve got the benefits. For example, patients will clearly see better outcomes if doctors can use top-drawer analytical tools to predict how treatments will work or know well in advance if a patient’s condition is about to go south.  And hospitals will clearly run better if execs get insights into issues that cross clinical and administrative boundaries, such as ED or OR utilization.

On the other, you’ve got the reality that big data projects are prohibitively expensive for all but the best-funded of healthcare organizations, and probably won’t produce returns on investment for several years at best.  Average community hospitals won’t be consolidating and analyzing their data this way anytime soon.

HHS OIG Begins Digging Into EMR Overbilling Allegations

Posted on November 5, 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.

Well, it had to happen: The furor over the possible EMR-related Medicare overbilling has moved to its next stage.  After enduring harangues by members of Congress and a widely-read New York Times article alleging that EMRs were upcoding machines, HHS has begun to look into the matter directly.

Fraud investigators within the HHS’s Office of the Inspector General have sent a 54-question survey to hospitals who got Meaningful Use incentive payments between January 1, 2011 to March 31, 2012. The survey looks into assertions that hospitals and physicians using EMRs have been inflating Medicare claims.

The logical next step for the OIG’s office is to issue a report to Congress spelling out whether it has reason to believe EMRs are linked to Medicare overbilling. The OIG will doubtless do some chart pulling and analysis to see whether it finds suspicious-looking patterns.

As I’ve said before — and will continue to say, doubtless — this whole effort concerns me. I’m not suggesting that HHS should ignore any evidence it has that hospitals or doctors are using EMRs to engineer a billing joyride. On the other hand, “overbilling” can be in the eye of the beholder, and conducting an inquisition into EMR user behavior seems premature to me.

I find myself wondering whether the feds have seriously considered hospitals’ response to these charges — that EMRs aren’t generating overbilling schemes, but instead are merely capturing and documenting services which weren’t always captured in the days of paper records.  It’s a credible argument and deserves a closer look.

So, let’s  hope HHS takes a breath and looks at the benign possibilities providers have outlined before it accuses hospitals and practices of wrongdoing. Otherwise, we’ll have a agency simultaneously pushing for EMR adoption and hanging the sword of Damocles over the heads of doctors and hospitals.

EMR Overbilling Investigations Sling Mud At Meaningful Use Program

Posted on October 31, 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.

In the wake of an expose in The New York Times claiming that upcoding and overbilling was increasing with the use of EMRs, and members of Congress riding the claim, I guess ONC had no choice but to take the allegations seriously.  So fearless leader Farzad Mostashari, M.D. has asked the advisory HIT Policy Committee to study whether providers are using EMRs to upcode Medicare bills.

I suppose you can tell from how I put that that I’m far from convinced EMRs are generating massive amounts of illegitimate bills, but the idea is “out there” now and dangerous to the future of HITECH objectives. So I suppose it’s a good thing that ONC is investigating.

Dr. Mostashari wants to find out whether EMRs tend to foster the use of higher billing codes by encouraging doctors to cut and paste information from one patient encounter to another, according to an interview with the Center for Public Integrity. He’s also asking the policy committee to determine whether some EMR functions prompt physicians to overbill.

All of this leaves me sort of uneasy.

Don’t get me wrong, I’m not suggesting that EMRs aren’t generating any upcoding issues at all. We all know that many physicians feel pressured to cut and paste text in an effort to get through their heavy workloads, particularly if they’re not otherwise comfortable with their system.

Also, I can’t deny that there are bad apples in every profession, including medicine, who could conceivably be taking advantage of the newness of the technology to reap a profit.

No, my concerns are more that countless providers will have one more thing to worry about as they use the new technology, and that policymakers will view EMRs with a level of suspicion they hadn’t before.  We’re at a tricky point in the overall EMR adoption curve, and bad vibes and publicity are the last thing we need. Meaningful Use compliance is tough enough as it is.

Healthcare Cloud Spending Slated For Major Growth

Posted on October 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.

Hospitals may still be ambivalent about using the cloud for clinical data transport, but attitudes are likely to undergo a major change over the next few years, according to research firm MarketsandMarkets. The firm projects that the healthcare cloud market will expand by about 20.5 percent per year over the next five years, hitting $5.4 billion by 2017.

Right now, healthcare cloud spending has hit roughly $1.8 billion, which represents penetration of four percent, MarketsandMarkets found.  That’s just a drop in the bucket, particularly given the big competitors who are aiming their guns at the healthcare cloud market today. (Other estimates put healthcare cloud penetration at 16.5 percent of the marketplace, still a small number though meaningfully larger than MarketsandMarkets’ number.)

As our sister site EMRandHIPAA.com previously noted, Verizon’s Enterprise Solutions division is offering five “healthcare-enabled” services, including colocation, managed hosting, enterprise cloud, an “enterprise cloud express edition” and enterprise cloud private edition. Verizon hopes to capture healthcare IT managers who are worried not only about HIPAA-secure clinical data transport, but also HIPAA-appropriate data protection on site, as it’s training hosting workers to be HIPAA-ready.

Another set of deep pocketed healthcare cloud vendors are AT&T and IBM, who are partnering to capture what they deem to be a $14 billion healthcare cloud market.  Under the terms of an agreement announced in early October, IBM will provide data storage facilities and services, while AT&T will provide the network.

What could possibly hold back the advance of such giants?  Well, a number of issues, MarketsandMarkets notes. While vendors large and small may promise to be compliant with healthcare regs, healthcare data is challenging to manage, given that it requires special security, confidentiality, availability to authorized users, traceability of access, reversibility of data and long-term preservation.

My guess is that hospitals will respond to the efforts of vendors to attract cloud business, but that the market for public cloud services in particular won’t shoot upward as MarketsandMarkets predicts, as there’s just too many things that worry CIOs.  How about you, readers?