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CommonWell Alliance Goals Challenged By ONC

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.

April 8, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

EMR Vendors Need To Get Their Act Together

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?

March 22, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Epic Not Invited To CommonWell Interoperability Alliance

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.”

March 7, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Top Inpatient EHR Vendors – 2013 Black Book Rankings

I think that most of you know how I feel about the various EHR ranking systems. They all have their issues, but they are another interesting data point in the search for the right EHR. Plus, the EHR ranking trends over time can be interesting. Not to mention, it’s hard not to look at a post that has rankings. It’s almost un-American not to look.

So, I figured I’d post some of the Black Book Rankings over the next week. The following are the Top Ranked EHR Vendors for Inpatient Hospital Systems, Chains and IDN (in alphabetical order).

4MEDICA
ALLSCRIPTS
CPSI
EPIC
GE HEALTHCARE
HCS EMR
HEALTH MANAGEMENT SYSTEMS
HEALTHLAND
INFOMEDIKA
KEANE
MCKESSON
MEDITECH
NEXTGEN
PROGNOSIS HIT
QUADRAMED
SEQUEL
SIEMENS
UNI/CARE
VERSASUITE

Not too many surprises on the list. Was their any Hospital EHR vendor that you think should have made it on this list? I think this list would be more interesting if it just ranked the top 5 Hospital EHR vendors.

February 22, 2013 I Written By

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

Other EHR Options When Epic Denies You

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?

January 18, 2013 I Written By

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

A Hospital Chooses VistA EMR Over The Giants

Here’s a story out of the pages of Forbes which should make open source advocates happy. In it, we hear the tale of a northern California hospital which decided to buck corporate trends and go with VistA rather than pay for a big-ticket EMR from a vendor giant.

Three years ago, at the outset of its EMR search, Oroville Hospital was going down the same path as most of peers. But the CEO wasn’t terribly happy with that path. While the 153-bed hospital had shortlisted giants like Cerner, McKesson and Meditech as possible candidates, chief executive Robert Wentz was worried about the sky-high cost, disruption and — as a smaller facility — lack of clout with vendors, Forbes reports.

Shunning conventional choices, Wentz decided to take a risk on VistA. Not only did he go with the less-conservative choice, he decided not to partner with companies like Medsphere that help hospitals integrate and develop VistA to meet their needs. Instead, he chose to work with independent VistA experts (a rogue crew with day jobs of their own) rather than be tied to a particular vendor.

To coordinate the project, Wentz worked with the non-profit WorldVistA and Vista Expertise Network, both of which embrace hundreds of programmers with VistA smarts. Wentz worked with programmers from the two groups, not only to build  out the hospital’s EMR but also to develop additional add-ons such as an e-prescribing package. WorldVistA CIO helped Oroville get its package certified for Meaningful Use, which brought in $5 million.

Now, three years into the project, Oroville has spent about $10 million on its EMR, about one-half of what it expected to spend on the giant EMR-makers’ software.

Now, it’s worth bearing in mind that Wentz and his IT team had to be more flexible than they would have if an army of consultants from Cerner or Epic had run the show. (I love the part in the Forbes story where a programmer told Wentz he had to end the call so he could make a trip to Costco. Classic.)  But Oroville seems to have reaped the benefits.  I wonder if this story will lead to more VistA adoption…

January 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Top 10 Hospital EHR Vendors By Installed Systems

I came across this list of Top 10 Hospital EHR vendors by installed systems on Dark Daily (a great resource, particularly if you’re into Labs). The data is a little dated, but I thought it would be interesting to consider the numbers in 2011 and how they might look different today. Here’s the list:

Vendor Name Total Installations Percent of Installations
• Meditech 1212 25.50%
• Cerner 606 12.80%
• McKesson 573 12.10%
• Epic Systems 413 8.70%
• Siemens Healthcare 397 8.40%
• CPSI 392 8.30%
• Healthcare Management Systems 347 7.30%
• Self-developed 273 5.80%
• Healthland 223 4.70%
• Eclipsys (Bought by Allscripts) 185 3.90%

This list was taken from the HIMSS Analytics database. I wish I had access so I could compare these numbers for 2012. The interesting thing is that I’m not sure the Hospital EHR vendor numbers would be all that much different. Epic is the media darling, but its focus is squarely on the large hospital systems so they often lag behind when it comes to total installations.

December 21, 2012 I Written By

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

Study: VistA Is Doctors’ Favorite EMR, Beating Epic

Despite more than a decade to work things out, discussions about open source vs. commercial enterprise software always seem to devolve into “religious wars” over the inherent goodness of one business model over the other.  EMR software seems to be no exception to this rule, a state of affairs which has done little to advance the industry as a whole.

Well, maybe the following will help move the discussion into more positive channels.  According to a new survey by Medscape, physicians prefer VistA over Epic, as well as Cerner, Meditech and McKesson, on characteristics which included ease of learning, reliability, value for the money, physician overall satisfaction and staff overall satisfaction.

According to the study, VistA came in at 3.89 out of 5 (five being “like most”), while Epic followed at 3.51, Cerner at 3.15, Meditech at 2.94 and McKesson at 2.91. (The pack was actually led by Amazing Charts (4.22) and Practice Fusion (4.04), both systems aimed at physician practices directly.)

Lest this seem like a flash in the pan, consider the results of a similar study done by the American Academy of Family Physicians in 2011. The AAFP, which asked physicians to compare 30 EMRs on 15 criteria. Of enterprise EMRs included in the study, Epic and VistA were neck at 5th and 6th, with McKesson 19th and Cerner 25th in line.

Now, in all fairness, it should be noted that the author of the blog item I mined for this piece is Edmund Billing, MD, CMO and EVP of Medsphere, whose product is OpenVista. But the stats outlined by Dr. Billing are worth considering nonetheless.

Perhaps we’re not ready for the religious wars to end, but throwing some relevant stats into the conversation couldn’t possibly hurt.  After all, there’s never a bad time to take physician perceptions seriously.

November 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.

Hospitals Rarely See the Whole EHR Financial Picture

Chris O’Neal is Managing Partner at KATALUS Advisors. KATALUS Advisors is a strategic consulting firm focused on the healthcare vertical. We serve healthcare technology vendors, hospitals, and private equity groups in North America, Europe, and the Middle East. Our services span growth strategies in new and existing markets, M&A due diligence, market analysis, and advisory services. www.KATALUSadvisors.com

Most hospital CFOs we have worked with readily acknowledge the fact that it is extremely difficult for them to find the time and manpower necessary to build an entire 10-year cost projection for an enterprise IT project. Accounting for every external and internal variable that could affect the total cost of ownership (TCO) is a monumental task and can easily take many weeks and cost tens of thousands of dollars’ worth of internal resources to do so adequately.

While seemingly overwhelming, the additional benefits and possible penalties around EHR purchases should make such a task imperative, especially for cash-strapped hospitals which have no time or financial room for a misstep of such gravity.

In research our team recently conducted on how hospitals estimate TCO for EHR purchases, we found that the real surprises in required cash outflows often come years down the road and outside the scope of traditional cost-estimation models which only reflect near-term purchase and implementation costs. For example, major upgrade (or version upgrade) costs can be a large differentiator in TCO projections. When looking at these upgrades as a percentage of upfront contract value, it is easy to see the importance of having a comprehensive, long-range TCO model which accounts for future costs:

Have you experienced financial “surprises” of your own with unexpected costs?

August 14, 2012 I Written By

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

Top HIS Vendors By 2011 Revenue: Cerner Corp. (CERN)

Today it’s back to our countdown of the top five HIS vendors, with data courtesy of HealthDataManagement magazine. Today we’re focusing on Cerner, which according to the magazine’s calculations ranks second for HIS sales, edged out only by McKesson.

Cerner claims to be the top EMR vendor in the U.S., despite competitor McKesson’s much larger size, since McKesson is in so many other lines of business. As with McKesson, we’re going to share a very quick overview of Cerner’s position in the overall HIS market, which as noted previously embraces not only clinical tools like EMRs, but also HIM, revenue cycle and access tools.

Cerner holds a very tasty 18 percent of the HIS market, by HDM consultants’ calculations. More interesting, to this audience at least, is that it’s gotten there with a big helping hand from its suite of EMR products. Here’s more to chew on, below.

-Anne

Cerner Corp. (CERN)
2800 Rockcreek Parkway
North Kansas City, MO 64117
Phone: 816-221-1024

Products:  For the purposes of this discussion, let’s just be cute and say “everything HIT.”  That includes its popular Millennium suite of EMR products which are really seeing a big uptake in community hospitals, especially its remote hosted solutions.

2011 HIS Revenue: $2.2 billion

2010 Revenue: $1.85 billion

Summary:  From 2010 to 2011, Cerner’s  HIS revenue grew by 20 percent as Millenium sales yielded annual revenues of $2.2 billion.  Cerner’s overall profit margin for last year was, wait for it, just about 14 percent — and over the last 52 weeks its stock is up 34.3 percent. Yeah, yeah, I’ve been an editor for 20 years but now I know I’m in the wrong business.

Interesting facts:  Cerner has a strong international presence, from Belgium to Bangladesh, the Middle East and South America. Also, it now is offering “Community Works” to Critical Access Hospitals under 25 beds (a move your editor wouldn’t have expected given the predictably high cost of solutions from a company that size).

April 23, 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.