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

Posted on April 23, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

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).

Idea That Might Work: “Hospital at Home” Model Delivers Hospital-Level Care

Posted on November 27, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Far too often, ideas developed by academics end up sitting in a dusty file or published by an insider journal that hospitals CEOs seldom see. In the following case, however, it seems academia and the hospital biz are seeing eye to eye on a new approach to acute care which could offer substantial savings.

A growing number of hospitals have begun to embrace the “Hospital at Home” model, an approach originally developed by the Johns Hopkins School of Medicine which offers hospital care to people in their own homes. HAH is focused on the elderly, not surprisingly given the high cost of caring for them, but I bet it’d offer advantages in caring for chronically-ill patients of just about any age.

While this approach isn’t as whiz-bang neat as, say, bringing an emergency department to a patient’s home — something already done in France — it’s a solid concept.

This model fits hand in glove with maturing technologies which monitor patients from afar while leaving in their home (tracking metrics like blood sugar, patient weight or cardiac functioning and shunting the data to doctors via the Internet).

According to a recent Forbes article, one of the biggest proponents of this approach is Presbyterian Healthcare Services, a New Mexico-based system which manages the largest program in the country. PHS has estimated that treatment averages one-third shorter than equivalent cases treated in an inpatient setting. And the system calculates that it’s saved $2,000 to $3,000 per case, as well. Neat stuff.

Folks, frankly I’m mystified that this approach hasn’t become more standard…or would be, I suppose, if the hospital industry I know and love didn’t have this habit of ignoring trends until they explode in someone’s face.

In any event, if any of you are implementing or even considering HAH, I’d love to hear from you. And if you think that this model can’t work, I’d love hearing from you even more. Let me have it!

Beware: EMR Installs Could Slow ED Throughput

Posted on November 9, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s hard to argue that in the wake of an EMR install, some processes are likely to slow down or even break. What makes the following study interesting is that it attempts to do something intriguing —  sorting out how EMRs  affect emergency department throughput they’re implemented.

A new study appearing in the Journal of the American Medical Informatics Association concludes that EMR installs have a distinct impact on ED processes, as well as patient length of stay.

Researchers with the Cincinnati Children’s Hospital Medical Center attempted to track the impact an EMR install had there by looking at how often non-acute patients got routed to alternate sites.  Specifically, they looked at how often potential victims of the H1N1 flu virus were routed to non-acute sites before and after the Center did its implementation.

The hospital phased its EMR rollout in over two years, setting the ED section of the rollout for November 2009, a date which overlapped with the peak of t he H1N1 outbreak in its region. During that period, the hospital set up an overflow clinic — staffed by non-ED providers — to deal with patients who had flu-like illnesses.

The overflow clinic began seeing 50 to 60 patients per day, 10 to 20 percent of the ED’s volume, within two weeks, but plunged to pre-surge levels by November 2009, researchers reported in JAMIA.  While 10 percent or more of patients were being diverted prior to the ED rollout, that total fell to 5 percent afterwards, the study concluded.

Another intriguing finding was that length of stay in the ED went up markedly during the implementation. LOS in the emergency department was 24 to 53 minutes for admissions, and 9 to 19 minutes for discharges prior to the EMR rollout; during EMR implementation, LOS for both groups was greater than the pre-overflow clinic block and the H1N1 overflow clinic block by 32 to 62 minutes for admits and 35 to 44 minutes for discharges.  If reproducible, those are some serious numbers.

Of course, there’s a long ton of confounding factors here, including but not limited to the fact that patient flow in the H1N1 outbreak may be significantly different in important ways than the standard patient population. For all I know, the H1N1 diversions were not too hard to identify, which could mean that the EMR would  have had a worse impact if the virus wasn’t raging.

That being said, the question it asks — what impact the EMR rollout has on the “front door to the  hospital” — is one that deserves more attention. Rest assured that if I get more data on this subject I’ll be reporting it here.

 

Hospital merger mania on the rise across the U.S.

Posted on April 30, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As I reported a few days ago, hospital mergers and acquisitions hit a historic high last year.  This is shaping up to be a pretty frenzied year for hospital M&A as well.  In fact, this may be the year that hospitals see a historic change in how they’re managed and they define themselves.

How much merger activity will we see?  At the HIMSS11 event earlier this year, John Reiboldt of Coker Capital Advisers suggested that the single stand-alone hospital may be a “concept of the past.”

While the comment by Reiboldt may have been a bit tongue-in-cheek, it’s clear that many smaller hospitals and health systems are giving up long-held independence in an effort to survive.

What’s more, such deals seem to be getting a friendlier reception from the Department of Justice and the FTC, which revised its Horizontal Merger Guidelines in August of last year.

A few randomly chosen examples of regional mergers underway:

* The merger between Albany-based  St. Peter’s Health Care Services, Northeast Health and Seton Health/St. Mary’s Hospital is should close shortly.  After three years of talks, the three entities have gotten the FTC’s blessing to move ahead.

*Alongside of its massive effort to acquire Tenet, Community Health Systems has signed a definitive agreement to acquire Mercy Health Partners, a three-hospital system based in northern Pennsylvania.

* Peoria, IL-based OSF Healthcare may absorb Rockford (IL)  Healthcare System, despite some degree of public hostility to the proposal (and complaints from rival SwedishAmerican Health System.

I see no reason why this consolidation should slow down this year, particularly as reform deadlines grow closer. And I fully anticipate that hospital mergers will create a ripple effect that tips other industries into new formers of cooperation.  Fasten your seat belts — this year is proving to be a wild ride.

Google takes over hospital industry, CMS in private leveraged buyout

Posted on April 18, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Read the headline?  Those are things that just aren’t going to happen, right?

Well, I’m pretty sure the things that we can expect for the next few years will end up looking just about that strange when we read about them a decade later.

My personal faves are a) Accountable care organizations dominate U.S. healthcare system, b) Most hospitals are connected to doctors via EMR and c)  Emergency departments no longer swamped with uninsured patients.

Anyone else want to volunteer “future headlines” — stuff that might come true but seems impossible at the moment? Or stuff that should happen but just can’t?  Sarcastic or serious, your choice.

So, you got your crystal ball out?  I’ll publish all of your predictions, crazy or not. 🙂

The great sucking sound: For-profit buyouts a drain on communities

Posted on December 14, 2010 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Few have spent more time than I calling out non-profit hospitals on their inadequate charity care levels.  But when it comes down to

This picture shows a panorama of Boston (USA).

Boston, there's a new predator in town

it, I’d prefer a non-profit whose chain can be yanked over a for-profit with no public service requirements at all.

I was reminded of my concerns this week when I heard about the two hospitals Cerberus Capital Management agreed to acquire this week.  It’s picking the hospitals up from Essent Healthcare, another for-profit.  Cerberus, a New York-based private equity firm, just spent $900 million for the six-hospital non-profit chain Caritas Christi. That gave them a nice foothold in Boston, an incredibly competitive but opportunity-rich environment.

Really, both of deals the two-headed guardian of the afterlife has chosen seem to be good ones — for them.  While I’m not privy to much financial information on any of the eight hospitals, we do know that Caritas Christi was in big trouble financially.

I’d wager that the other two hospitals, which lie in the Boston suburbs, are in bad need of a capital infusion to prop them up during these bad times.  This situation allows the firm to swoop in, buy equipment, get things shipshape and get their money many times over.  Oh, and probably do a nice job of squeezing the health plans, now that they’re getting critical mass. Again, good for them.

The thing is, I strongly doubt that any private equity firm is going to have the interests of the community in mind.  One way or another, in most of the private equity buyouts I’ve followed, all of the extra money generated by improvements ends up in the bulging bank account of the PE guys.  They’re not in ANY investment for the long term; that’s just not what they do.  They’re there to pillage, however, legally, and get the hell out.

Far too often, PE players get into a deal, drag the hospitals down financially and then more or less shrug their shoulders when the facility plunges into the red.

The PE firm doesn’t give a rat’s patoot — they’ve made their money. The often-struggling community is left with, well, not a whole lot.

I’d argue that this is a travesty.  We need, as professionals and healthcare consumers, to keep hospitals as community asset with a strong bank account and a long-term view.

So, my question to you is this. Is it inevitable, during this period of transition to full-out reform, that community hospitals get decimated?

Bigger, better, faster hospitals are a great idea

Posted on December 13, 2010 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Nagoya City University Hospital in Kawasumi

Image via Wikipedia

The other day, I read a tweet from the estimable Matthew Holt in which he summarized what hospitals have been telling him.  In short, they seem to want bigger, badder, newer facilities.  In fact, if I recall correctly, they feel they’re in deep mud if they don’t get these  upgrades and/or new facilities soon.

OK, usually I take such statements with a grain or two of salt. After all, who  — in any industry — doesn’t want the latest and greatest, from the toys we squabble over on up into adulthood?  But in this case, I think we should be taking Holt’s feedback quite seriously.

After all, despite the fact that I’m not an architect, hospital CEO, designer  or any variation on same, I can immediately think of a few very important reasons for a massive buildout of hospitals to improve care and meet today’s process standards:

*  Shared rooms are right out.  There are already a fair number of hospitals (no stats to hand but this IS happening) who are converting all shared rooms to single rooms within their facility.  Their main rationale is infection control, but I think they’re also hoping to streamline the care process by allowing nurses to think rationally, about one patient a time.

*  Older physical plants are a huge liability. When you’ve got a house full of sick people, the last thing you want is a drip from that 20 year old pipe, asbestos to remediate, mold in ancient ducts and so on.  While maintenance will be an issue for any facility, we’ve learned a lot since the first wave of current hospitals were built. Let’s get rid of ’em ASAP.

*  If you’ve ever owned a house from the 70s (and I have) you know that they leak air conditioning and heat out at a ferocious rate.  Sure, you can weatherstrip and insulate and hang curtains to seal out air from the windows, but eventually, it starts to cost so much that it’s a big waste.  A new place — or hospital — is much cheaper over the long run.

*  And while they’re at it, hospitals newly-designed hospitals can be planned with green energy usage in mind — a trick which might not work out in a clumsy plant from decades a ago.  That not only helps to save the earth, it can save big bucks too.  Again, I don’t have a case study handy but Google “green hospitals” and  you’ll find some heartening stories.

* Oh, and I almost forgot…old hospitals can be a nightmare for techs to work around.  Whether you’re talking about simply making sure Wi-Fi gets to every corner of the building or rolling out an EMR, nobody needs to live with design flaws from the 60s.

So, though I’m surprised to say it, it seems to me that bigger, better, faster hospitals are indeed what the doctor ordered.  We’re not talking self-glorifying projects approved by boards to prove they’ve got the juice to make it happen, we’re talking simply about getting with the times.   Let’s hope plenty of hospitals find the means to do so.

Would you feel safe in this ugly lobby?

Posted on November 21, 2010 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A patient having his blood pressure taken by a...

Image via Wikipedia

Folks, I’ll never forget that night.  Led gently by my worried husband, who was a bit concerned about my ability to keep breathing, I walked into the lobby of a mid-sized, plain-vanilla 100-odd bed community hospital in my neighborhood.

I already knew, from phone calls to my PCP, that I probably had pneumonia. And I knew that while I probably didn’t need an admission, I definitely needed a hand.  My temp was 104, my cough was in the Black Plague range  and I could barely walk.

So, then medical reality collided with nice, warm, compassionate medical theory.  The details aren’t important — basically, since the ED staff had nowhere appropriate to put me while I waited, and demanded I wear a mask I simply could not tolerate  — I ended up sitting on the floor inside the glass box between the outside and inside doors to the facility.  At least the cold from the winter night kept my temp down a bit.

I’m sorry, but I absolutely cannot fathom why even a not-so-rich community hospital can’t do more to make very, very uncomfortable and scared people feel safe when they enter an ED door.

Why are hospitals spending SO much energy advertising their abbreviated ED wait times?  Customer service, right? Well, guys, I can assure you that it makes more sense to start with EDs that aren’t a nightmare to visit. Get people through quickly? Sure. But for the time they’re in the lobby, much less in case, make that time welcoming and safe.

Yes, I realize not every hospital will spend enough to put Pottery Barn-style couches and deluxe coffee and tea service out there, but what bothers me is that comfort doesn’t seem to be anyone’s aspiration when patients arrive.

The nursing staff in the emergency departments I’ve visited are largely abrupt and impatient, refusing to make the slightest human connection with patients.  The lobbies themselves stack uncomfortable institutional chairs and horrible lighting on top of one another in a graceless manner which rivals sitting in the New York City subway at 2AM.  And if you want food or drink you often have to go on a hunting expedition you’re in no position to conduct.

My take? This is not acceptable. No. Not for a second.  I don’t want to hear any excuses about it.

If your hospital can’t afford high-toned decor, maybe get a volunteer to serve as a concierge to help make people comfortable. Rent a goddamned cot or two for patients who aren’t dying but feel like they want to.  Provide some hot liquids, for Christ’s sake — it’s not going tap out the budget for a mid-sized community hospital.  Remind your front-desk nurses that people are in pain, and base part of their pay on the reports you get from patients.

You know, evidence is piling up that patient satisfaction correlates pretty strongly with profit.  If compassion and common sense aren’t enough to convince the hold outs that it’s time for them to make their front door inviting, I guess nothing will.

Meaningful Use: What is it good for? A lot of smoke and mirrors

Posted on November 19, 2010 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

EHR Adoption Framework_AD

Image by andyde via Flickr

Meaningful Use?  Whoa! Good God y’all! What is it good for?  Very, very little. Sing it again…

OK, maybe it’s the greatest idea in the history of health IT, or maybe it’s a good idea gone terribly, terribly wrong (my theory), but it it’s not going to move hospitals along any faster than they are already toward smart, sophisticated IT use that saves lives.  There are efforts out there that do stand a chance of improving IT use (take your pick from dozens, which I’ll get to in another post), but has anyone provided clinical, social science or other data suggesting that going to MU first was the best way to spend all of this time and money?

After my months-long absence from the blog that I love (<grin>) I’m freshly charged up with looks to me like another major distraction from improving quality.

Here’s my logic: check me  out here and see if you agree. The harder the government comes down on hospitals, the more dust will get swept under the rug.  And when that “dust” is inefficient processes that stand a chance of killing people,we’re not talking any kind of joke here.

Want an idea of why I’m so skeptical?  Here’s a few (why not a  couple of bonuses):

*  Just got off the phone this week with a children’s hospital CEO, who’s found that 20 percent or less of his colleagues are ready for meaningful use.   And check out an Information Week article below, which reports that just 40 percent of hospitals  meet 5 MU criteria. Wow.

*  Why has it suddenly become a priority, in recent years, to automate processes at the bedside before the processes themselves have been perfected?  When Your Editor attended a conference this week on healthcare IT topics, the bedside came up a lot, but not much talk on whether we’ll be running into a GIGO problem.

* Medical groups and hospitals are under great pressure to form Accountable Care Organizations, a new entity for which there are some precedents (decades of capitation) but no clear-cut model.  With doctors and hospitals struggling to create the most basic levels of partnerships, is now a good time to pressure them to form their work habits around their IT investments? Yeah, yeah, they’re suppposed to fund and find EMRs and HIEs that meet their needs but really, how often will that happen?

If you’re a big MU fan, well, I’m sorry if I offended you.  But I’d much rather you flame the heck out of me here so we can have a nice dialogue on the subject. This is important stuff, people.

Did hospital “kidnap” patient who wanted to leave?

Posted on September 2, 2010 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

 

Hospital? Or prison?

 

OK folks, I don’t know any more about the following story than you do, but if true, it’s an absolutely insane breakdown in hospital systems — one, I’d argue, that might not have happened in a hospital which had its, uh, finances and operations together.

The beginning of the tale sounds pretty routine. Apparently, Joseph Wheeler and his wife Felicia Ann, both in their mid-40s, were in a car accident in June and brought to Cheverly, MD-based Prince George’s Hospital.  In theory, this should have been a relatively simple case, as neither was gravely injured.

Now, let’s take a pause. Prince George’s is part of the Dimensions Healthcare System, a financially troubled institution which brought on a new CEO and an interim EVP  last month. The system, which has been forced to accept funding from the state in the past, expects to begin a restructuring plan in coming weeks.  It’s also looking for capital sources, natch.

So, back to the Wheelers.  Joseph Wheeler spent the night of June 23rd at the hospital, being treated for blunt torso trauma without other acute injuries.  The next morning he wakes up, finds a woman’s ID badge on his wrist, and is told he’s getting surgery “to have a potentially cancerous mass removed from his chest,” according to ABC News.   Need I tell you that he freaked out?

Well, all hell broke out at that point, according to the Wheelers, who have since filed a $12 million lawsuit against the hospital for false imprisonment, assault and battery and infliction of emotional distress.  According to Mr. Wheeler, he couldn’t get hospital staff to take an interest in the fact that the badge was for a woman 13 years younger than himself, so he and his wife decided to leave. 

Unfortunately, when they tried to leave the campus, they were accosted by security guards with a big chip on their shoulder. Two guards cursed the two out, then beat Mr. Wheeler severely, while attempting to take the incorrect ID bracelet away from him, the suit claims.  Ultimately, the facility let him go when Wheeler signed a form admitting he was leaving against medical advice.  He was treated at a nearby hospital with several new injuries, his suit recounts.

So, is this just an unbelievable aberration?  Has the financial strain the hospital faced left it with scared, poorly trained employees who simply got out of control?  What do you think?