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EMR Usability A Pressing Issue

Posted on January 29, 2016 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 few months ago, in a move that hasn’t gotten a lot of attention, the AMA and MedStar Health made an interesting play. The physicians’ group and the health system released a joint framework designed to rank EMR usability, as well as using the framework to rank the usability of a number of widely-implemented systems.

What makes these scores interesting is not that they’re just another set of rankings — those are pretty much everywhere — but that the researchers focused on EMR usability. As any clinician will tell you (and many have told me) despite years of evolution, EMRs are still a pain in the butt to use. And clearly, market forces are doing little to change this. Looking at where widely-used systems rate on usability is a refreshing look at a neglected issue.

To score the EMRs, researchers dug into EMR vendor testing reports from ONC. This makes sense. After all, though the agency doesn’t use this data for certification, the ONC does require EMR vendors to report on user-centered design processes they used for eight capabilities.

And while the ONC doesn’t base EMR certifications on usability, my gut feeling is that the data source is pretty reliable. I would tend to believe that given they’re talking to a certifying authority, vendors are less like to fudge these reports than any they’d prepare for potential customers.

According to the partners, Allscripts and McKesson were the highest-scoring EMR vendors, gaining 15 out of 15 points. eClinicalWorks was the lowest-scoring EMR, getting only 5 of 15 possible points. In-betweeners included Cerner and MEDITECH, which got 13 points each, and Epic, which got 9 points.

And here’s the criteria for the rankings:

  • User Centered Design Process:  EMRs were rated on whether they had a user-centered design process, how many participants took part (15+ was best) and whether test participants had a clinical background.
  • Summative Testing Methodology: These ratings focused on how detailed the use cases relied upon by the testing were and whether usability measures focused on appropriate factors (effectiveness, efficiency and satisfaction).
  • Summative Testing Results:  These measures focused on whether success rates for first-time users were 80% or more, and on how substantive descriptions of areas for improvement were.

Given the spotty results across the population of EMRs tested, it seems clear that usability hasn’t been a core concern of most vendors. (Yes, I know, some of you are saying, “Boy howdy, we knew that already!”)

Perhaps more importantly, though, it can be inferred that usability hasn’t been a priority for the health systems and practices investing in these products. After all, some of the so-so ratings, such as that for the Epic product, come from companies that have been in the market forever and have had the time to iterate a mature, usable product. If health systems were demanding that EMRs be easy to use, the scores would probably be higher.

Frankly, I can’t for the life of me understand why an organization would invest hundreds of millions of dollars (or even a billion) dollars in an EMR without being sure that clinicians can actually use it. After all, a good EMR experience can be very attractive to potential recruits as well as current clinicians. In fact, a study from early last year found that 79% of RNs see the hospital’s EMR as a one of the top 3 considerations in choosing where to work.

Maybe it’s an artifact of a prior era. In the past, perhaps the health systems investing in less-usable EMRs were just making the best of a shoddy situation. But I don’t think that excuse plays anymore. I believe more providers need to adopt frameworks like this one, and apply them rigorously.

Look, I know that EMR investment is a complex dance. And obviously, notions of usability will continue to evolve as EMRs involve — so perhaps it can’t be the top priority for every buyer. But it’s more than time for health organizations to take usability seriously.

Athenahealth Amps Up Drive To Build Inpatient EMR

Posted on January 26, 2016 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.

EMR vendor athenahealth has been driving forward for a while now to build a new hospital inpatient system and fight for the big-ticket customers in acute care. Given the intense competition for the acute care EMR dollar, I’m skeptical that athenahealth can wedge its way into the game. But so far, it looks like the vendor is going about things the right way.

athenahealth already offers the athenaOne suite, which includes an ambulatory EMR, revenue cycle management and patient engagement tools. But it seems the ambitious execs there have also decided to participate in the bare-knuckled fight for hospital bucks being duked out between Cerner, Epic, MEDITECH, McKesson and Allscripts. Considering the billions at stake, these acute care giants won’t be gentle. But as the following details suggest, athenahealth may just have enough going for it to slip into place.

Last year, athenahealth got the ball rolling when it struck a co-development deal with Boston-based Beth Israel Deaconess Medical Center to create a new inpatient system. The two organizations agreed to kick off the development work at Beth Israel’s 58-bed hospital, which is located in the nearby suburb of Needham, Mass.  The deal makes particular sense given that athena corporate is located in another Boston suburb, Watertown.

To supplement its development efforts, athenahealth also picked up small-hospital EMR vendor RazorInsights and Beth Israel’s home-built webOMR EMR. athena has replaced the RazorInsights EMR with a rebuilt version of its ambulatory athenaClinicals EMR, and integrated it with the RI hospital information system, plus several ancillary systems. This hybrid system is being sold to the small-hospital market.

athenahealth has begun converting webOMR into athenaNet in partnership with the small Needham branch of Beth Israel, working with clinicians and technical staffers to better understand the inpatient care environment.

That agreement alone might have gotten the job done, but athena didn’t stop there. Last week, the vendor announced that it would be partnering with the University of Toledo Medical Center to further speed the development of its inpatient EMR. The agreement clearly builds on the vendor’s prior relationship with the University of Toledo Physicians, which picked up the athenaOne suite in late 2014.

The deal with UTMC will do more than give athenahealth another testbed and development site. This agreement with the health system, which is dumping its McKesson Horizon system by 2018, gives athenahealth a real-life win in a substantial setting. What’s more, given that the medical center is being given the chance to build things to its liking, the new acute-care EMR is unlikely to cost as much over the long-term as, say, Epic support and maintenance.

I must admit that I still see athenahealth’s plans as fairly risky. While it has significant resources, the vendor can’t match those of its big competitors. What’s more, it could lose a great deal if it endangers its strong legacy base of ambulatory users. But if any of the established ambulatory HIT firms have a shot at the bigger deals, this one does. I’m eager to see how this turns out.

RNs are Choosing Where to Work Based on Hospital EHR

Posted on February 27, 2015 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 came across this tweet and it made me stop and realize how important the selection and more important the implementation of your EHR will be for your organization. In many areas there’s already a nurse shortage, so it would become even more of an issue if your hospital comes to be known as the hospital with the cumbersome EHR.

Here’s some insight into the survey results from the article linked above:

79% of job seeking registered nurses reported that the reputation of the hospital’s EHR system is a top three consideration in their choice of where they will work. Nurses in the 22 largest metropolitan statistical areas are most satisfied with the usability of Cerner, McKesson, NextGen and Epic Systems. Those EHRs receiving the lowest satisfaction scores by nurses include Meditech, Allscripts, eClinicalWorks and HCare.

The article did also quote someone as saying that a well done EHR implementation can be a recruiting benefit. So, like most things it’s a double edge sword. A great EHR can be a benefit to you when recruiting nurses to your organization, but a poorly done, complex EHR could drive nurses away.

I’m pretty sure this side affect wasn’t discussed when evaluating how to implement the EHR and what kind of resources to commit to ensuring a successful and well done EHR implementation. They’re paying the price now.

Investor Wants to Take Down Epic

Posted on October 13, 2014 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 recently came across a really interesting comment from Chamath Palihapitiya, a venture capitalist (made his money working at Facebook), who commented on the healthcare industry and how he wanted to invest in a startup company that would take down Facebook. I embedded the full video below. His comments about EHR and Epic start at about 52:38 or you can click here to see it.

Here’s a great quote for those who can’t watch the video:

“Somebody has to go after the electronic medical record market in a really big way. Let’s go and take down this company call Epic which is this massive, old conglomerate. It’s like the IBM of healthcare.”

After saying this, he talks about how he and other VC investors like John Doerr could call people from Obama (for meaningful use stage 3) to Mayo Clinic to help a startup company try and take down Epic. He even asserts that he’d call Mayo Clinic and suggest that they should rip out Epic and go with this startup company.

Everyone reading this blog know that it won’t be nearly this simple to convince any hospital that’s on Epic to leave it behind. I agree with Chamath that it will happen at some point, but it won’t be nearly as easy as what he describes. Chamath also suggested that it might take $100 million and you might fail, but what a way to fail.

It certainly provides an interesting view into the way these venture capitalists and many startup companies approach a problem. However, I take a more nuance and practical approach of how I think that Epic will be disrupted. I think that it will require a mix of a new technology paired with a dynamic CIO that’s friends with the hospital IT leadership. You need that mix of amazing technology with insider credibility or it won’t be a success. Plus, you’re not going to go straight in and take out Epic. You’re going to start with a hospital department and create something amazing. Then, that will make the rest of the hospital jealous and you’ll expand from there until you can replace Epic. That’s how I see it playing out, but it likely won’t happen until after the MU dollars are spent.

Chamath’s comments were also interesting, because it shows that he doesn’t know the healthcare market very well. First, he said that meaningful use was part of ACA, but meaningful use is part of ARRA (the HITECH Act) and not ACA. This is a common error by many and doesn’t really impact the points he made. Second, he said that Epic is a big conglomerate. Epic is the farthest thing from a conglomerate that you can find. Has Epic ever acquired any company or technology? Cerner, McKesson, GE, etc could be called conglomerates, but Epic is not. Again, a subtle thing, but shows Chamath’s depth of understanding in the industry. It makes sense though. He isn’t an expert in healthcare IT. He’s an expert in seeing market opportunities. No doubt, disrupting Epic and Cerner would make for a massive company.

5 Year Projected Growth Rate for Healthcare Analytics Market

Posted on July 30, 2014 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.

iHealthBeat recently reported some interesting data on the Healthcare Analytics market growth:

The market for health care analytics is projected to increase at a 25% compound annual growth rate between 2014 and 2019,according to a new report from Research and Markets, Health IT Analytics reports (Bresnick,  Health IT Analytics, 7/24).

If anything, I’d suggest that this is a conservative growth rate for the Healthcare Analytics market. If you go into any hospital, health analytics is one of the only thing they’re spending new money on.

In the same article linked above they suggested these companies as the major players:

  • Inovalon
  • LexisNexis
  • McKesson
  • Oracle
  • Predixion
  • SAS
  • Truven Health Analytics
  • Verisk Health

I agree that these companies will be involved, but I’m more interested in the newer Health Analytics companies that are entering and going to enter the market. We’ll see how that plays out since it seems like pretty much every healthcare IT company is creating some sort of health analytics offering.

What are your hospital’s healthcare analytics plans?

KLAS: Epic Losing Ground To Cerner

Posted on September 6, 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.

At this point in the EMR buying cycle, one would figure that the market for new hospital EMR purchases is pretty saturated, especially among larger hospitals with the capital to invest in big health IT projects. But according to a recent blog entry from KLAS, that’s not exactly the case.

In his blog item, KLAS researcher Colin Buckley notes that his firm has been watching clinical IT vendor wins and losses at 200+ bed hospitals for 10 years.  During that period — and especially post- Meaningful Use — KLAS has seen a growing number of new hospital EMR contracts.

By this point, after lots of EMR buying, and some switching out technology for second and third-choice EMRs, one might think that over-200-bed hospitals had settled on a platform that they could live with through Meaningful  Use Stage 3. Actually, not quite, Buckley says.

In fact, KLAS data shows that there are more hospitals running legacy EMRs, homegrown EMRs or no EMR at all than those who have bought a currently-marketed solution sometime in the past four years. And it’s likely these hospitals will be choosing a new EMR from the current vendor marketplace within the new few years, KLAS projects.

As sales increase in the 200+ bed hospital segment, market forces are shifting to favor new vendors. What’s particularly noteworthy about this is that the research firm has seen the ratio of Epic-to-Cerner wins shrink from 5-to-1 in 2010 to 2-to-1 in 2012.

According to KLAS, the hospitals that are likely to be out buying new EMRs look different than those which have already bought and implemented the EMR they’ll use for the next several years. “They are smaller and more cost conscious than the large hospital IDNs that have given Epic a lion’s share of wins year after year,” Buckley writes.

With Cerner and Epic busy eating each other’s lunch, Allscripts, MEDITECH, McKesson and Siemens are moving ahead as quickly as possible to roll out integrated ancillary and ambulatory solutions, Buckley notes. In other words, the competition for both ambulatory and hospital EMRs is far from played out.

Despite all of this activity, we are clearly in a late stage of the EMR market as a whole, or as my colleague John Lynn puts it, “the Golden Age of EHR adoption is over.” But if KLAS is right, there’s still some very healthy bucks to be made selling to laggard mid-sized hospitals. Let’s see if vendors used to serving hospital giants can adapt in time.

Business Intelligence And The Smart EMR

Posted on July 26, 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.

A new study by KLAS suggests that while providers are giving thought to business intelligence needs, they still haven’t honed in on favored vendors that they see as holding a leading position in healthcare. That may be, I’d suggest, because the industry is still waiting on EMRs that can offer the BI functionality they really need.

To look at the issue of BI in healthcare, KLAS interviewed execs at more than 70 hospitals and delivery systems with 200 or more beds.

When asked which BI vendors will stand out in the healthcare industry, 41 percent of respondents replied that they weren’t sure, according to a story in Health Data Management.

Of the other 59 percent who chose a vendor, IBM, SAP, Microsoft and Oracle came up as leaders in enterprise BI applications — but none of the above got more than 12 percent of the vote, HDM notes.

Vendors that did get a nod as standing out in healthcare-specific BI included Explorys, Health Catalyst, McKesson and Humedica (Optum). IBM and Microsoft were also singled out for healthcare use, but respondents noted that their products came with high price tags.

Meanwhile, QlikTech and Tableau Software were noted for their usability and data visualization tools though lacking in full BI toolsets, according to HDM.

While these stats are somewhat interesting on their own, they sidestep a very important issue:  when will EMRs evolve from transaction-based to intelligence-based systems?  After all, an intelligence-based EMR can do more to improve healthcare in context than freestanding BI systems.

As my colleague John Lynn notes, EMRs will ultimately need to leverage big data and support smart processes, becoming what he likes to call the “Smart EMR.”  These systems will integrate business intelligence natively rather than requiring a whole separate infrastructure to gather insights from the tsunami of patient data being generated today.

The reality, unfortunately, is that we’re a fairly long way away from having such Smart EMRs in place. Readers, how long to you think it will take before such a next-gen EMR hits the market?  And who do you think will be the first to market with such a system?

CommonWell Alliance Goals Challenged By ONC

Posted on April 8, 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.

As virtually everyone in health IT knows, HIMSS saw the dawning of a new EMR vendor alliance which proposes to make health data exchange simpler.  The group, the CommonWell Alliance, includes McKesson, Cerner, Allscripts, Greenway and athenahealth, plus McKesson’s connectivity business RelayHealth.

Now that the PR fairy dust has settled and we’re talking serious business, it’s a good time to consider exactly what these vendors hope to accomplish, as we’re talking about enough vendor muscle to have a serious impact on the way health data is shared.

This week, ONC released a report doing just that, according to a piece in Government Health IT.  At a meeting of the Health IT Policy Committee on April 3, National Coordinator for Health Information Technology Farzad Mostashari, MD and other committee members discussed the report, which raised some hard questions about the Alliance.

According to Government Health IT, the report outlined the following as CommonWell’s chief goals:

  • Enabling providers to unambiguously identify patients – but not with a national patient identifier;
  • Providing a way to match patients with their healthcare records as they transition through care facilities;
  • Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
  • Enabling patients to manage consent and authorization;
  • Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
  • Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
  • Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.

Unlike most standards-setting efforts, members of the group are going to have to pay if they want to participate, a nice little detail that wasn’t made clear when CommonWell was announced.

Though it will be at least a year before CommonWell pilots its approach, members of the Committee are quite appropriately wondering now about the impact of such an effort.

Dr. Mostashari argued that the key question is whether the service will work as an optional overlay across a regional exchange, or whether it requires exclusive participation. Other committee members agreed.

The bottom line for committee members, Government Health IT reports, is that they’re willing to take a wait-and-see approach. As for us out here in the peanut gallery, I believe we should challenge the heck out of this thing.

Members of the Health IT Policy Committee are well advised to wonder whether this coming together of powerful HIT vendors could undermine broader efforts to foster interoperability. There’s a lot to look into here, even if the allmighty Epic never joins.

EMR Vendors Need To Get Their Act Together

Posted on March 22, 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.

For quite some time now, EMR vendors have gotten away with selling products that aren’t very usable and may even pose safety risks. But that’s the price enterprise EMR buyers have been willing to pay to jump in and automate. Very soon, though, vendors may be held to a higher standard, a new report from KLAS.

KLAS recently held a bake-off comparing Allscripts, Cerner, Epic, McKesson’s Paragon, Meditech 6 and Siemens’ Soarian EMRs head to head where it comes to usability and efficiency, SearchHealthIT reports. The study looked at how the products worked for individual users, and then looked at how they meet organizational quality of care demands.

Some of the EMRs  — and I wish SearchHealthIT had told us which ones — took a full month for physicians to learn. In some cases, physicians who were willing to take that month ended up with a richer experience than those which were easy and quick to learn, while in other cases, the darned thing still wasn’t usable.  Of course, those with long learning curves and unimpressive features suffered from low physician adoption, the  publication notes.

This is all interesting enough, but what grabbed me about the story was a provider quote from an end user, supplied by KLAS:

“As suggested by the new 2014 certification standards, vendors should take more responsibility for both the usability and safety of their products. These responsibilities shouldn’t be the sole purview of healthcare organizations and providers like they have been until now.”

Could it be that providers have finally gotten to the point where they’re no longer going to put up with unusable products and bring the hammer down even on giants like the big-shouldered group listed above?  After all, so far providers have swallowed hard and accepted a lot of ugly technology.

Maybe Meaningful Use demands are finally giving health organizations the backbone they need to stand up to Jabba the Hutt vendors?

Epic Not Invited To CommonWell Interoperability Alliance

Posted on March 7, 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.

Well, well, well. Far from refusing to participate, it looks like Epic may have been caught off-guard when a group of EMR players announced at HIMSS that they’d formed an interoperability alliance, according to a story appearing in Forbes.

For those who haven’t heard, Cerner, McKesson, Allscripts, Greenway Medical Technologies and athenahealth announced this week that they were forming the CommonWell Health Alliance, a non-profit dedicated to promoting interoperability between their products. Epic was conspicuously absent from the list of participants.

At the announcement’s outset, commentators like yours truly assumed that Epic, in its imperial way, had refused to join the party.  After all, McKesson CEO John Hammergren had told the press that “everyone in the industry” had been invited to take part in the club.

But no, apparently this isn’t the case. “No, we were not asked to join,” Carl Dvorak, COO of Epic told the business magazine’s Zina Moukheiber. “We found out about it when you guys did.”   Perhaps Epic wouldn’t have joined anyway — Dvorak is more of a fan of existing interoperability standards — but leaving a $1.5 billion EMR company off of the eVite list is pretty conspicuous too.

In the article, by the way, Dvorak repeats Epic’s often-made claim that their product isn’t a closed platform, stating that one-third of Epic EMR transactions are with non-Epic systems.  In fact, he says that Epic can already connect with Greenway, Cerner and Allscripts, as well as NextGen. I’m not sure everybody reading this will take that statement face value.

Invited or not, Dvorak doesn’t miss the chance to get off a shot at the CommonWell guys nonetheless. He argues, as I have, that CommonWell may be more of a PR play than a real forward movement for interoperabiility. “It’s a marketing opportunity [for vendors],” he told Forbes. “They create the perception of leaders in the space, where they’re followers.”