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Is Allscripts An Also-Ran In The Hospital EMR Business?

Posted on August 18, 2017 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.

It all began with a question, as many classic tales do. Someone writing for the HIStalk.com website  – I think it was ever-anonymous, eponymous  leader Mr. HISTalk – asked readers to answer the question “Who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?”

The survey results were themselves worth a read:

* Approximately 29% voted for “McKesson customers”
* About 27% voted for “Allscripts customers”
* 8.4% voted for “McKesson shareholders”
* Roughly 23% voted for “Allscripts shareholders”
* About 13% voted for “Allscripts competitors”

Two things about these responses interested me. One is that almost a third of respondents seem to think McKesson will make the bigger score after being acquired by Allscripts. The other is that a not-inconsiderable 13% of the site’s well-informed readers think the deal will help Allscripts’ competitors. If these readers are right, perhaps Allscripts should rethink the deal.

I was even more engaged by the analysis that followed, which the writer took a close look at the dynamics of the hospital EMR market and commented on how Allscripts fit in. The results weren’t surprising, but again, if I were running Allscripts I’d take the following discussion seriously.

After working with data supplied by Blain Newton, EVP of HIMSS Analytics, the writer drew some firm conclusions. Here are some of the observations he shared:

  • While McKesson has twice as many hospitals as Allscripts, most of these hospitals have less than 150 beds, which means that the acquisition may offer less benefit, he suggests.
  • In addition to having only 3% of hospitals overall, Allscripts controls only 6% of the 250+ bed hospital market, which probably doesn’t position it for success. In contrast, he notes, Epic controls 20% of this market and Meditech 19%.
  • His sense is that while hospitals typically want a full suite of products when they work with Epic, Cerner or Meditech, Allscripts customers may be more prone to buying just a few key systems.
  • Ultimately, he argues, Cerner, Epic and Meditech have a commanding lead in this market, for reasons which include that the three are well ahead when it comes to the overall number of hospital served.
  • Given his premise, he believes that Epic is at the top of the pyramid, as it has almost double the number of hospitals with 500+ beds that Cerner does.

To cap off his analysis, Mr. HISTalk concludes that market forces make it unlikely that a dark horse will squeeze out one of the top hospital EMR vendors: “Everybody else is eating their dust and likely to lose business due to hospital consolidation and a shift toward the most successful vendors as much as all of us who – for our own reasons – wish that weren’t the case.”

It would take a separate analysis to predict whether the top three hospital EMR vendors are likely to win out over each other, but Epic seems to hold the most cards. Last year, I wrote a piece suggesting that Cerner was edging up on Epic, but I’m not sure whether or not my logic still holds. Epic may indeed be King of the (HIT) Universe for the foreseeable future.

Achieve MU3: Measure 3 with these 5 MEDITECH Clinical Decision Support Interventions (CDSi)

Posted on August 11, 2017 I Written By

The following is a guest blog post by Kelly Del Gaudio, Principal Consultant at Galen Healthcare Solutions.

Over the past several years, there has been significant investment and effort to attest to the various stages of meaningful use, with the goal of achieving better clinical outcomes. One area of MU3 that directly contributes to improved clinical outcomes is implementation of Clinical Decision Support Interventions (CDSi). Medicaid hospitals must implement 5 CDSi and enable drug-drug and/or drug-allergy checking.

From looking at this measure it seems like a walk in the park, but how does your organization fair when it comes to CDS?

Thanks to First Databank, users of EMR’s have been accomplishing drug to drug and drug to allergy checking for over a decade, but what about the edge cases you think will be covered but aren’t? Take a patient that is allergic to contrast for example. Since imaging studies requiring contrast are not drugs, what happens when they are ordered? Are they checking for allergies? In most cases, additional configuration is required to get that flag to pop. This is usually where we come in.

Let’s take a look at a simple CDSi definition provided by CMS.gov

“CDS intervention interaction. Interventions provided to a user must occur when a user is interacting with technology. These interventions should be based on the following data:  Problem list; Medication list; Medication allergy list; Laboratory tests; and Vital signs. “

Without a decent rule writer on staff, there are limitations within MEDITECH for accomplishing full CDSi. The primary reason we started recording these discrete data elements in the first place is the glimmer of hope that they would someday prove themselves useful. That day is here, friends. (If you don’t believe me, check out IBM’s Watson diagnosing cancer on YouTube. . .you might want to block off your schedule.)

In collaboration with 9 hospitals as part of a MEDITECH Rules focus group – Project Claire[IT] – we researched and designed intuitive tools to address Clinical Quality Measures (eCQM’s) and incorporated them into a content package. If your organization is struggling to meet these measures or you are interested in improving the patient and provider experience, but don’t have the resources to dedicate to months of research and development, Project Claire[IT]’s accelerated deployment schedule (less than 1 month) can help you meet that mark. Below are just some examples of the eCQM’s and CDS delivered by Project Claire[IT].

CMS131v5     Diabetes Eye Exam
CMS123v5     Diabetes: Foot Exam
CMS22v5       Screening for High Blood Pressure and Follow-Up Documented

Synopsis: The chronic disease management template will only display questions relevant to the Problem List (or other documented confirmed problems since we know not everyone uses the problem list). Popup suggestions trigger orders reminding the provider to complete these chronic condition follow-up items before letting the patient out of their sights. Our goal was to save providers time by ordering all orders in 1 click.

CMS71v7     Anticoagulation Therapy for Atrial Fibrillation/Flutter
CMS102v6   Assessed for Rehabilitation

“The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation.” – CMS71v7

The above quote is taken directly from this measure indicating the use of the Framingham Heart Study we used to identify and risk stratify stroke. Claire[IT] content comes complete with three Framingham Scoring tools:

                Framingham Risk for Stroke
                Framingham Risk for Cardiovascular Disease
                Framingham Risk for Heart Attack

These calculators use all the aforementioned data elements to drive the score, interpretation and recommendations and the best part is they only require one click.

*User adds BP. BP mean auto calculates. Diabetes and Smoking Status update from the Problem List. Total Cholesterol and HDL update from last lab values.
Ten year and comparative risk by age auto calculates.

*User adds BP. BP mean auto calculates. Diabetes, Smoking Status, CVD, Afib and LVH update from the Problem List. On Hypertension meds looks to Ambulatory Orders.
Ten year risk auto calculates.

*User adds BP. BP mean auto calculates. Diabetes and Smoking Status update from the Problem List. Hypertension meds looks to Ambulatory Orders. Total Cholesterol and HDL update from lab values.
Ten year risk auto calculates.

CMS149v5      Dementia: Cognitive Assessment

Synopsis: Not only is this tool built specifically as a conversational assessment, it screens for 4 tiers of mental status within one tool (Mental Status, Education, Cognitive Function and Dementia). The utilization of popup messages allows us to overcome the barrier of character limits and makes for a really smooth display on a tablet or hybrid. Our popups are driven by the primary language field in registration and our content currently consists of English and Spanish translations.

CMS108v6     VTE Prophylaxis
CMS190v6     VTE Prophylaxis is the ICU

Synopsis: Patients that have an acute or suspected VTE problem with no orders placed for coumadin (acute/ambulatory or both) receive clinical decision support flags. Clicking the acknowledge tracks the user mnemonic and date/time stamp in an audit trail. Hard stops are also in place if NONE is chosen as a contraindication. The discharge order cannot be filed unless coumadin is ordered or a contraindication is defined. These rules evaluate the problem list and compare it to the medication list to present the provider with the right message.

Learn more about the work of our focus group and Project Claire[IT] by viewing our MEDITECH Clinical Optimization Toolkit.

VIEW THE TOOLKIT TO ACCESS:

  • Deliverable Package of Complex Rules, Assessments, CDS’s and Workflows
    • Problem List Evaluation
    • Total Parenteral Nutrition
    • Manage Transfer Guidance
  • Surveillance Dashboard Setup Guide
    • Dictionary Setup & Validation
  • 6.x Rules Setup Guide
    • Basic Rules for Assessments, Documents & Orders
  • IV Charge Capture Setup Guide

About Kelly Del Gaudio
Kelly is Principal Consultant at Galen Healthcare Solutions, and has been optimizing MEDITECH systems for over 10 years. She worked for MEDITECH on an elite 4-person team (the MEDITECH SWAT Team), whose sole concentration was clinical optimization, ROI analysis, MU certification, and achievement of HIMSS EMRAM Stage 6/7. Kelly currently leads Galen’s MEDITECH practice, and championed a focus group, which led to the delivery of Project Claire[IT], a MEDITECH content package of complex rules, assessments, CDS’s, and workflows that evaluate, suggest, and support documentation of chronic and acute problems. Learn more about Kelly in the #IAmGalen series.

About Galen Healthcare Solutions

Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the EMR Clinical Optimization Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Top Hospital EMR and EHR Blog Posts for 2016

Posted on December 30, 2016 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.

It’s that time of year when you look back at the past year and think about what you’ve accomplished. At Hospital EMR and EHR, we like to look back at the stats for the top blog posts we’ve published. It’s always interesting to see what’s resonated with people. Plus, it’s interesting to see how things have changed since we’ve posted on a topic. So, without further ado, here’s a look at the top blog posts in 2016 for Hospital EMR and EHR along with some commentary on each.

1. Why Is It So Hard to Become a Certified Epic consultant? – This is by far the top post generating 4-10 times as much traffic as the posts below.  It’s also why I’ve wanted to make the time to do a whole series of blog posts on Epic Certification and along with it Cerner Certification, MEDITECH Certification, etc.  When you make something like Epic Certification hard to get, people want it even more.  It’s just too bad they’re so closed since it drives up the prices for Epic consultants and thus the cost to implement Epic.  Certainly, we’ll be writing about this more in the future.

2. NYC Hospitals Face Massive Problems With Epic Install – This was a big story back in 2013 and still is today.  We should probably look at doing a follow up story to see what’s happening at NYC hospitals a few years after this story hit.

3. Epic Install Triggers Loss At MD Anderson – No surprise, people love to read about challenges in EHR implementations.  We saw quite a few of these from Epic in 2016 and people were interested in what went wrong.  The problem from the outside is it’s really hard to know who is to blame for the failure.  What has become clear over this year is that many healthcare organizations are blaming Epic for their revenue issues.

4. Hospital EMR and EHR Vendors – This page needs some work, but no doubt many people want to know who the big players in the hospital EMR and EHR market are.  This is true if they’re selecting a new EHR, switching EHR or looking to partner with EHR companies.

5. Why Do People Dislike Epic So Much? Let Me Count The Ways – This post is 5.5 years old and still going strong.  I imagine many people are still counting the ways they hate Epic.  I think I read that Epic finally hired a PR person.  Maybe that new hire can work on this.

6. A Study on the Impact of ICD-10 on Coding and Revenue Cycle – This was a good study that illustrated the impact of ICD-10.  It also gave some good words of caution about the impact of ICD-10 going forward.

7. Epic EMR Costs Drag Down Finances At Brigham and Women’s – Another example of the cost to implement Epic.  I knew this was a hot topic this year and the stats show that people were interested in the details.

8. The Argument for Meditech – I can’t believe this post is 5 years old already, but it still rings true today.  MEDITECH is not without its challenges, but it also doesn’t get the credit it deserves either.  I had a chance to visit their offices near Boston this year.  I’ll be really interested to see where MEDITECH takes their product next.  Many people have counted them out, but I certainly haven’t.

9. Can HIM Professionals Become Clinical Documentation Improvement Specialists? – We’ve published a lot about the changing world of HIM thanks to our new series of HIM Scene blog posts.  This post was a great example of how there are a lot of new opportunities for HIM professionals that are willing to embrace change and adapt as needed.

10. Great Healthcare IT Leaders – This is a great list of healthcare IT leaders as shared by David Chou.  David made the case for meeting up with them at HIMSS 2016, but the nice part is thanks to social media you can follow most of them year round.

An honorable mention to the 11th post on the list which talks about Dr. Rasu Shrestha helping an injured passenger on his way to HIMSS 2016.  Love stories like this.  Did you have a favorite post on Hospital EMR and EHR?  Was there an idea or concept you read on Hospital EMR and EHR?  We’d love to hear about it in the comments.

Cerner Tops List Of Hospital Vendors For Medicare EHR Incentive Program

Posted on September 28, 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.

Research from the ONC concludes that Cerner systems are in use by the most hospitals using certified technology to participate in the Medicare EHR Incentive Program. It’s interesting to note that this list includes players that rarely appear on overall lists of top hospital EHR vendors, though admittedly, there’s no one way to measure market dominance that produces consistent results every time.

According to ONC statistics, there were 175 vendors supplying certified health IT to 4,474 nonfederal acute-care hospitals participating in the Medicare EHR Incentive Program. Ninety-five percent of these vendors have 2014 certified technology.

The report notes that six of these vendors (Cerner, Meditech, Epic, Evident, Medhost and McKesson) provide 2014 certified technology 92% of hospitals using the technology. When you throw in athenahealth, Prognosis and QuadraMed, bringing the list to 10 vendors, you’ve got a group that supplies 2014 technology to 98% of eligible hospitals.

According to the data, the vendors at the top fall in as follows. Cerner tops the list of total hospitals using its certified health IT, with 1,029 hospitals;  Meditech was next with 953 hospitals; Epic came in third with 869 hospitals; CPSI’s Evident (formerly Healthland) was fourth with 637 hospitals; McKesson fifth with 462 hospitals; and Medhost sixth with 359 hospitals.

As is usually the case with any attempt to look at market share, the data comes with its own quirks. For example, when looking at ONC’s data as of July 2016 on ambulatory healthcare providers choice of certified technology, Epic was way ahead of the pack with 83,674 users. Allscripts came in at a distant second with 33,123 users. Cerner came in sixth with 15,100 ambulatory users. In other words, vendors one might class as “enterprise” focused are doing well among clinicians. (See more data along these lines in a Medscape survey I summarized previously.)

Then consider data from HIMSS Analytics, which concludes that Epic has 40% of the hospital health IT market, followed by Cerner at a distant second with 13%, Allscripts at 10%, Meditech at 7% and eClinicalWorks at 5% and NextGen with 4%. Why the big difference in numbers? It seems that HIMSS Analytics includes the size of the hospital in its calculations versus the ONC data above which talks about the number of hospitals.

No doubt the buying patterns vary when you look at the number of beds a hospital has. For example, according to research done last year by peer60, CPSI and eClinicalWorks held the biggest share of the market among facilities with less than 100 beds, MEDITECH, McKesson and Siemens dominated the mid-sized hospital categories, and as the number of beds rises from 250 to 1000+ plus, Cerner and Epic emerge as the top players.

The truth is, market share numbers are interesting, and not just to the vendors who hope to emerge on top. Everyone loves a good horse race, after all. But it’s good to take these numbers with a large dose of context, or they mean very little.

Is It a Hot or Cold Hospital EHR Buying Market? – Response

Posted on August 15, 2016 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

This article is in response to John Lynn’s recent posting, Is It a Hot or Cold Hospital EHR Buying Market?

In his recent posting, John Lynn asked the question “Is it a Hot or Cold Hospital EHR Buying Market?”. In it he highlights a recent KLAS report that over 490 hospitals, a staggering 10% of the entire market, were involved in an EHR decision in 2015. After reading his posting, I wanted to take a moment to share my observations.

2015 was indeed an amazing year for EHR sales, partly driven by the pending sunset date of Mckesson Horizon forcing many customers to switch EHR solutions. Some of those customers are going to Paragon, but many more purchased or are evaluating other solutions. During a recent trip to Epic University, I was surprised to find that nearly half of the attendees of the classes were hospitals switching from Mckesson Horizon to Epic – and all had just recently completed their purchases (late 2015/early 2016) and were facing the same live dates of late 2017/early 2018.

Hospitals who have purchased and implemented Epic or Cerner are very unlikely to make a change. Regardless of which solution is preferred, the investment in these solutions and the level of effort required to switch from one to another is so high, that it would take a significant triggering event for a hospital to make that change. Therefore it is likely that customers on these solutions will not be making a change in the near future.

However, KLAS reports that nearly 40% of MEDITECH customers would change EMR’s if they could, and that Paragon customers also report unrest. Therefore in addition to the shrinking number of those that have not implemented a viable EHR solution, the possibility that there will be a wave of customers switching from one of these solutions to Epic or Cerner remains a consideration. There is also the question of how the recent spin-off of Mckesson’s software division will impact the future of Paragon. If Paragon were discontinued or sold, it could lead to another explosion of EHR decisions. If instead there was a significant investment in the solution, it could become a more viable alternative as customers look to switch from one EHR to another.

I suspect that 2016 will be another strong year from EHR sales in general and for Epic and Cerner in particular. Beyond that, much will depend on the strength of the other solutions and which ones break out into the top tier. Regardless, the recent explosion of EHR sales and the rush to replace Horizon will in many cases lead to minimized installs – where the bare minimum work was completed and there is significant opportunity to improve business processes, implement new modules, and roll out advanced functionality within those solutions. As a result I believe that within a few years, the market will be more stabilized with fewer customers switching solutions, and instead focusing on maximizing what they have.

Unless another player comes in and disrupts the marketplace or a significant shift in the industry creates a reason to make a change yet again…

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

The Rise of the “EHR Value” Equation at Hospitals

Posted on July 1, 2016 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’ve heard a lot of people talk about how it will be impossible for ambulatory EHR vendors like athenahealth and eCW to break into the acute care market. For those following along at home, both companies have announced that they’re building out their EHR software for the acute care market. These are big bets by both companies, but I think many people don’t realize the advantage these companies will have going into the very expensive hospital EHR market.

Companies like eCW and athenahealth will be able to come into a hospital with a native cloud platform that will let them offer some really aggressive pricing. When you’re paying $50+ million for an EHR (or $9+ billion for some), there’s a lot of wiggle room for a new entrant to enter the fray at a much lower cost point. That lower cost point will totally change the EHR value equation for hospitals. In fact, these cloud based hospital EHR will likely be able to compete effectively against a legacy EHRs upgrade costs alone.

Don’t believe this is possible? Take a look at the story about Delta Regional Hospital returning to MEDITECH. Why did they do it? Thomas Moore, vice president and CFO at Delta said, “We were looking for a system with a lower cost of ownership without sacrificing quality.” Moore later added this comment, “MEDITECH is a company that truly understands the meaning of value.”

During the wild west phase of EHR where the industry was propped up by $36 billion in stimulus money, everyone had the perfect rationale for spending hundreds of millions (and even billions) on EHR software. As we return to a more rational market we’re going to see hospital CIOs starting to place a much larger emphasis on EHR value. Showing that value is going to be hard for some of the larger EHR vendors who’ve charged hundreds of millions and even billions of dollars to their customers. Plus, it will be hard for them to lower their price.

In one online thread I participate on, a bunch of people were bashing Delta Regional Hospital’s decision to go back to MEDITECH. However, a former CIO offered this great insight:

Ya gotta spend time in a Meditech shop. It’s not flashy, but from a value perspective (and it does a lot more than just EHR), it’s hard to beat.

The same is going to be true with acute care EHR from eCW and athenahealth, but they’ll have some of the sexy factor as well. In the acute care EHR world I believe we’re just entering the new world of EHR value. Those who can tell the story of the value they’ve created for customers are going to win. Plus, we’re going to see a fierce battle from new entrants who are going to try and undercut the market. Think about how the EHR value equation changes when you can charge even $75 million instead of $100 million. That’s a game changer.

A Look at MEDITECH’s Place in the EHR Marketplace and Where They’re Headed

Posted on February 12, 2016 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.

Healthcare Scene was lucky to sit down with Helen Waters, VP at MEDITECH, to talk about the EHR market and MEDITECH’s place in that market. Plus, we dive into the culture and history of MEDITECH and how it’s changed. We also explore MEDITECH’s plans around innovation, integration, and value along with MEDITECH’s efforts to deploy cloud and mobile solutions. Finally, we had to talk about healthcare interoperability. We hope you’ll enjoy this wide ranging interview with Helen Waters:

After the formal interview we did above, we allow people watching live to be able to ask questions and even hop on camera to offer their insights or ask questions of Helen in what we call the “after party.” In this “after party” discussion we talk to Helen about her thoughts on the changing healthcare reimbursement landscape and what MEDITECH is doing to prepare for it. We also talk about integrating telemedicine into MEDITECH. I also ask Helen about MEDITECH’s views on EHR APIs. Check out the second half of our interview below:

We hope you’ll enjoy this look into EHR vendor, MEDITECH.

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.

Meditech EHR Market Share

Posted on November 25, 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 recently got subscribed to the Navin, Haffty & Associates email newsletter. The title on their website claims they’re the “Largest and Most Respected MEDITECH consulting firm.” I’ll let you decide on those two counts, but they’re clearly all in as a consulting firm with MEDITECH. In their latest newsletter John Haffty, President of Navin, Haffty & Associates, shared some statistics on MEDITECH market share that I thought might be of interest to readers:

Statistically speaking, MEDITECH has over 2,400 clients. The number of MEDITECH clients by platform is outlined below:
Client/Server – 1,056
MAGIC – 848
6.x – 546

Over the past five years 285 clients have been added, 137 of which implemented 6.x. Clients often add their existing platform as they acquire hospitals and this has resulted in the addition of 22 MAGIC and 126 Client/Server sites. In addition, MEDITECH has signed 31 organizations for the new Ambulatory product. Of the 546 Ambulatory 6.x sites, 279 have chosen 6.1, with some already LIVE.

MEDITECH’s market share for hospitals by bed size demonstrates a strong industry presence:

23% – under 99 beds
36% – 100-199 beds
36% – 200-299 beds
27% – 300-399 beds
17% – 400+ beds

I’ve long argued that MEDITECH was still a sleeping giant in the EHR space. Epic and Cerner gets most of the headlines, but MEDITECH still has a massive market share. Of course, after CPSI’s acquisition of Healthland today, it looks like CPSI wants to play as well.