Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

MinuteClinic Goes With Epic – What’s It Mean?

Retail clinic operator MinuteClinic has decided to purchase and roll out the Epic EMR, upgrading from its home built system it’s used until now.  MinuteClinic, a division of CVS Caremark, expects the rollout to take about 18 months.

This is a big win for Epic.  An estimated 274,000 physicians will use the company’s EMR, and roughly 51% the US population will have a record in Epic when its current customer rollouts are complete.

And MinuteClinic has big expansion plans, which will bring Epic to a wide range of new environments.  According to Andrew Sussman, MD, president of Minute Clinic and senior vice president/associate chief medical officer, CVS Caremark,  the company is expanding rapidly, having added more than 350 clinics in the past three years, and planning to reach 1,500 clinics by 2017.

“EpicCare will take us to the next level by offering enhanced connectivity with other providers, more advanced patient portal capabilities and key analytics to run our practice more efficiently and improve patient care,” Sussman said in a press statement.

What’s particularly interesting about this deal is not just that Epic has racked up another big customer, though keeping an eye on their progress is definitely important. No, what’s more newsworthy is the possibility that epic is slowly but steadily changing its strategy, from selling only to large hospitals to exploring other customer relationships on the ambulatory side.

Not only is Epic rolling out a large ambulatory deal with MinuteClinic, the EMR vendor has struck a deal with the Cleveland Clinic and Dell under which the Clinic and Dell offer providers EMR consulting installation configuration and hosting service for Epic.  Bearing in mind the needs of ambulatory providers, the Cleveland Clinic deal even allows buyers to have the Epic EMR hosted mostly by Dell.

Certainly Epic won’t stop pursuing big hospital deals, but the MinuteClinic and Cleveland Clinic agreements suggest that Epic may be looking for other markets beyond the large hospital market. It looks like ambulatory is on their radar and we know they’ve been working hard to grow internationally.

March 12, 2014 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. Contact her at @annezieger on Twitter.

CMS Adds Vendor Unreadiness To Meaningful Use Hardship Exemptions

After watching providers struggle to get their vendors in line for the next round of attestations, CMS has decided to give hospitals a break where vendor unreadiness is concerned in meeting Stage 2 Meaningful Use requirements.

Until recently, lack of infrastructure and unforeseen or uncontrollable circumstances were the only criteria CMS would consider in granting hardship exemptions to providers struggling with reading Stage 2 requirements.

Now, CMS has taken a new step demonstrating that it understands that EMR vendors are not up to speed many cases. CMS has added “2014 EHR vendor issues” as an acceptable reason to receive a hardship exemption to Stage 2 requirements.

To qualify for this exemption, the hospital’s EHR vendor must have been unable to obtain 2014 certification of the hospital was unable to implement Meaningful  Use due to 2014 EHR certification delays. According to the form required to apply for this exemption, “circumstances must be beyond the Hospital’s control and the Hospital must explicitly outline of the circumstances significantly impaired the Hospital’s ability to meet Meaningful Use.”

CMS has also offered additional hardship exemptions to eligible professionals. Eligible professionals can use “lack of control over the availability of Certified EHR Technology” and “lack of Face-to-Face interaction” as well as EHR vendor issues lack of infrastructure and unforeseen/uncontrollable circumstances.

The expansion of hardship exemptions follows a letter that was sent by six Republican senators last week to CMS requesting clarification of the qualification criteria for the hardship program. The Senators, in their letter, asked CMS how hardship categories might be expanded.

As I see it, it’s good to give providers a break under these circumstances, as they can hardly control whether their vendors have their act together. The question is, how long can CMS continue to give providers and vendors exemptions without undermining their larger policy goals?

March 11, 2014 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. Contact her at @annezieger on Twitter.

HIE Study Finds That Failure To Use Data Cost $1.3 Million Over 18 Months

You can put an HIE in place, but you can’t make doctors drink. That fractured moral was demonstrated recently by an HIE in Western New York, which found that many doctors were failing to use data available in the HIE, and thus ordering CT scans that were unnecessary — wasting about $1.3 million over an 18 month period.

The HIE, HEALTHeLINK, recently conducted a study intended to put a specific value on how many potentially unnecessary duplicative tests were being ordered by providers in its region, as well as a potential savings to the health system.

The sample audience was comprised of patients who had received more than one CT scan within a six-month period on the same part of the body. Scans were then sorted into the three most common categories of CBT groupings — head and neck, chest, and abdomen.

The duplicate scans were divided into three separate categories: 1) studies in which the CT report clearly reference to previous CT scan, 2) inconclusive studies in which researchers were able to tell if the previous study was known prior to ordering the scan and 3) unknown studies in which the CT report clearly stated that no previous study was known of.

Some findings include the following:

* During the 18 month study, which drew on claims data from three major insurance carriers in the area, researchers found about 2,763 CT scans which were considered to be potentially unnecessary.

* About 90 percent of the potentially needless CT scans were ordered by physicians who never or infrequently used the HIE. And more than 95 percent of the identified potentially unnecessary CT scans were done in a hospital,

* About 50 percent of the patients who had a duplicate CT scan had already consented to have their data accessed (so patients weren’t the obstacle).

While the analysis is complex, the lesson seems to be fairly simple. HIE’s are missing out on producing cost reductions when doctors aren’t accessing them prior to ordering tests.

March 3, 2014 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. Contact her at @annezieger on Twitter.

ONC Releases Findings on Study of Patient-Matching Practices

The ONC has released findings from its study of patient-matching practices in the private sector and federal agencies.

Its conclusion: standardizing specific demographic fields within health IT systems and broad collaboration on industry best practices are two of the key steps the industry needs to take to make advances in patient matching.

In its study, ONC was looking to describe common data attributes, processes, and best practices to assess the industry’s current capabilities in this area. To do so, it did an environmental scan to get a look at current industry capabilities, literature review, feedback received at public meetings, collaboration with federal partner agencies and written comments stakeholders.

Problems it found include differences in the way names and addresses are formatted in various systems which can lead to high rates of unmatched records.

According to a story in FierceHealthIT, the study’s key recommendations include the following:

* Certification criteria should be introduced that require certified electronic health record technology to capture the data attributes that would be required in the standardized patient identifying attributes
* The ability of additional, non-traditional data attributes to improve patient matching should be studied
*Certification criteria should not be created for patient matching algorithms or require organizations to utilize a specific type of algorithm
*Work with the industry to develop best practices and policies to encourage consumers to keep their information current and accurate is necessary

With these me just at the suggestion stage, it’s evident that patient matching needs more attention.

In the past, the ONC has suggested hospitals create a standardized patient identifier during data transactions to make sure the right patient is matched with the correct information. But that won’t address the problem higher-order problem.

Simply being aware that data mismatches on patients a problem is a good first step, but it looks like we have a long way to go before data can be shared from institution to institution accurately without duplicate records and other errors of this type. Interoperability between institutions which allows for accurate patient matching is the real brass ring.

February 28, 2014 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. Contact her at @annezieger on Twitter.

Cleveland Clinic, Dell Offer Joint Epic EHR Service

Even when you’re a juggernaut the size of Epic, eventually you’re going to reach the point where your customer base is saturated and you need unique new directions to go. This new deal between Dell and the Cleveland Clinic may do just that for Epic.

This week at HIMSS, the two are announcing an agreement in which the two will offer consulting, installation, configuration and hosting services for Cleveland Clinic’s version of Epic. Under the deal struck between the two parties, customers can choose between a hosted version of the Epic instance and a full install on their site.

Cleveland Clinic execs say that their knowledge of using Epic, which they have for more than three years, will give them special expertise in helping providers adjust to Epic.  The Clinic has been selling Epic to providers  through its MyPractice Healthcare Solutions business.  To date, MyPractice has sold EMRs to more than 400 providers, including physicians, nurse practitioners and midwives within a 50 mile radius of Cleveland.

Working with Dell, the two companies plan to offer the new EMR service nationwide. The Cleveland Clinic will handle the EMR installation for new customers, and Dell provides the technology infrastructure. Epic gets a licensing fee for each of these deals, the customers’ relationship will be with Dell and the Cleveland Clinic.

As Dr. C. Martin Harris, CIO of the Cleveland Clinic, told Modern Healthcare, most medical practices and hospitals have EMRs in place, leaving only a much smaller group of first-time EMR buyers. But, Harris said, that minis still a big number. (And there’s always the practices still looking to switch.)

Turning Dell and the Cleveland Clinic into a sales channel for Epic seems like a pretty smart move. With the help of players who know the smaller physician practice market, it might open up a new opportunity for Epic which it hadn’t much of a shot at before.

February 27, 2014 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. Contact her at @annezieger on Twitter.

Post-Acute Facilities Behind On IT Use

A new report from research firm Black Book concludes that smart technology use will be essential to the health of post-acute facilities, which are struggling with Medicare reimbursement changes, more Medicaid patients and newly covered patients from insurance exchanges.

At present, post-acute facilities are still “stuck in a volume-based care mindset,” said Doug Brown, president of Black Book’s parent company, Brown-Wilson Group, in an announcement. “It is going to take a willingness to adapt and commit to using technology to confront the challenges ahead.”

Black Book surveyed 464 providers of long-term and post-acute care, including nursing homes, hospitals, short-term rehabilitation facilities, skilled nursing facilities and hospices in an effort to determine what strategic responses these facilities should make in response to a challenging reimbursement environment and higher demand for post-acute services.

The study, which focused on post-acute IT use, attempts to determine whether there are more efficient ways to improve such care using IT tools. The survey reported on health information exchanges (public and private), quality reporting, health analytics, workflow and care coordination, and patient engagement software/systems.

As things stand, 63% of all post-acute providers report extremely poor or non-existent use of information systems, technology and patient data exchanges, including 79% of all nursing homes and skilled nursing facilities. This is the case despite the fact that 92% of post-acute providers agree that IT platforms for patient data sharing a comprehensive care coordination would improve their organizations’ financial health, as well as improving their ability to function under accountable care systems and lower fee-for-service reimbursement.

To better manage the transition between inpatient care and post-acute environments, it will be necessary to connect physician practices, home health agencies, hospices, outpatient settings, skilled nursing facilities, rehabilitation centers, DME firms, and hospitals, said Brown.

February 17, 2014 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. Contact her at @annezieger on Twitter.

Meaningful Use Payouts Hit $19 Billion

The pace of meaningful use payouts has stayed strong of late, with CMS disclosing that it has disbursed more than $19 billion in EMR usage incentives. While hospitals have been particularly prone to stay on the meaningful use train, eligible providers are collecting their payouts too, according to Healthcare IT News.

According to CMS data, there were 440,998 registered providers participating in the federal EMR incentive program as of the end of 2013, who have to date received 19.2 billion in incentives.

About 88 percent of all eligible hospitals have been given EMR incentive payment so far, according to CMS officials.  Also, about 60 percent of Medicare eligible providers are meaningful users of EMRs, the agency reports.

And the meaningful use programs for Medicare and Medicaid are both active, with more than 340,000 eligible providers having received an incentive payments to their program. Medicaid eligible providers are distinctly less likely to be involved in the meaningful use program; only 20 percent of Medicaid EP’s are meaningful users.

What the Healthcare IT News article doesn’t discuss, but ought to, is that there is considerable evidence that many doctors are not willing to push beyond Stage 1 of meaningful use. Stats suggest that these doctors have little financial incentive to move ahead with Stage 2, and can’t afford the time or money to push through the MU 2 obstacles.

In other words, before CMS runs a victory lap, it might do well to see what’s happening with the doctors walking away from the program.

February 12, 2014 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. Contact her at @annezieger on Twitter.

KLAS Gives athenahealth, Not Epic, its 2013 “Best in KLAS” award

While Epic Systems may still be that the giant in the room, according KLAS, athenahealth is the best overall software vendor for 2013.

athenahealth’s taking first place pushes Epic to second for the first time in eight years. athenahealth got the most positive opinions from the thousands of providers participating in the KLAS poll, notably praise for the usability of its athenaClinicals, athenaCollector and athenaCommunicator products, according to EHR Intelligence.

athenahealth CEO Jonathan Bush was all too happy to take a victory lap. “The old guard of each IT leaders is finally being displaced by more nimble innovative models designed for healthcare’s future – not for its past,” Bush told EHR Intelligence.

Epic still remains in first place as for its overall software suite, reports EHR Intelligence. And it took home multiple prizes this year. But there’s a revolution brewing outside the Epic palace, it would appear. Not one that calls for angry peasants and pitchforks, but clearly some level of entrenched discontent is at work here.

Other well-known vendors of EMRs took their lumps as well. For example, Cerner came in at seventeenth, McKesson at 20th, and Allscripts came in 23rd.

So what to make of all of this? As my colleague John Lynn notes, awards of this kind are best taken with a grain of salt. After all, providers don’t need software that wins popularity contests, they need software which they can afford, which can handily meet Meaningful Use standards and which doctors and nurses and other clinicians can use without a hitch. Being sure their vendors win sexy awards really isn’t on their worry list.

Still, the fact that Epic has been unseated after eight years at the top of KLAS’s best vendor list may mean something. Perhaps Epic’s grip on the market is loosening a bit?

February 6, 2014 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. Contact her at @annezieger on Twitter.

KLAS Names Top EMR Vendors For Mid-Sized Practices

A new report by KLAS has designated Epic, athenahealth and Greenway as the top three EMR vendors among mid-sized healthcare practices.  The report, which also identified unpopular EMRs in the space, drew its conclusions based on analysis of ability, workflow and integration capabilities, according to iHealthBeat.

To do the study, KLAS interviewed clinicians and IT personnel at practices with 11 to 75 doctors.

Researchers named the top three mid-sized EMR vendors as Epic Systems, which scored a 85.3 points out of 100; athenahealth, which scored 83.5 points; and Greenway, which scored 81.3 points.

Each of the top three vendors distinguished themselves in unique ways.  For example, researchers found that practices liked Epic’s consistent delivery in large hospital-based practices, athenahealth’s “nimble deployment” and system updates, and Greenway’s exceptional service to smaller, independent practices.

Meanwhile, KLAS noted that Allscripts, McKesson and Vitera had the highest percentage of dissatisfied customers, practices which felt stuck with their current EMR system but would not purchase it again.  Reasons for their dissatisfaction included upgrade issues, lack of support, and a perceived lack of vendor partnership, iHealthBeat said.

When it comes down to it, it’s pretty clear when these practices need from their vendors, and a feeling of partnership and mutual support seems to top the list of matter which researchers is doing the study.  But it’s clear that these characteristics can be pretty hard to come by, even from companies you’d think had plenty of resources to deliver a sense of support and availability to their customers.  Allscripts, McKesson and Vitera (although it is Greenway now) had better get their act together quickly, as mid-sized medical practices are a major market, even if they don’t spend quite as much as hospitals.

January 27, 2014 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. Contact her at @annezieger on Twitter.

McKesson, Meditech Chosen As EHR Test Systems for Meaningful Use

Here’s an interesting situation which is just popped up on my radar screen.  CMS and the ONC have chosen the first two vendors to serve as designated test EHR systems, and they’ve gone with McKesson and Meditech.

These test vendors are there to help eligible providers meet the requirements of Meaningful Use Stage 2.  To meet MU Stage 2 requirements, providers must successfully conduct at least one exchange test with a CMS-designated test EMR. (The providers can also meet the requirements by performing one electronic exchange of a summary of care document with a recipient using a different EMR technology.)

What intrigued me about this is that CMS and ONC are starting out with only two vendors for use as test EMR providers.  Given the diversity in the marketplace, you’d think that CMS would want to have fuller stock of vendors lined up before it went forward announcing its plans.

If I were an eligible provider going this route, I’d want to have the choice of a wider range test EMRs. Given how little real interoperability there is between EMRs, I’d like to know that I had a fallback position if my original tests didn’t work out.  After all, nothing I’ve read here suggests that EPs won’t have a chance to try again if the initial testing doesn’t go through, and if I were a provider, it’d be good to know that I could take the shot with other test EMRs. But I could be wrong, and that could have an effect on whether vendors see this as a win.

Let’s see if other substantial EMR vendors take up the ONC’s call to serve as test EMR participants.  It will be interesting to see whether vendors see participation as a credibility-raiser or a chance to get pantsed publicly if interoperating with their systems is a pain.

January 23, 2014 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. Contact her at @annezieger on Twitter.