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Hospital Mergers Complicate EMR Transition

Getting an EMR up and running in a hospital or health system is complicated enough. But managing EMR implementations in the midst of hospital mergers is even more difficult.

Like it or not, though, hospital CIOs are increasingly facing the likelihood that they’ll be facing a merger in the midst of their EMR rollout, notes a new piece in the Wall Street Journal. With reimbursements from both Medicare and private insurers falling, hospitals’ margins are growing perilously thin, and the pace of hospital mergers is likely to increase, according to a March report by Moody’s.

Right now, for example, two of New York’s biggest hospital chains — NYU Langone Medical Center and Continuum Health Partners — have agreed to discuss a possible merger. Continuum CIO Mark Moroses is in the process of moving his chain of hospitals to its GE Centricity EMR, in a move which will allow the chain to collect $20 million to $30 million in Meaningful Use incentives.

If the merger between Langone and Continuum goes through, Moroses will have to stitch together dozens of billing,  procurement and patient care systems over the next few years, the WSJ notes. But more than that, the hospital chains will have to synchronize their clinical information management, a formidable job which, as Moroses says, leaves no room for error.

It’s not just systems integration that merging systems will face, however. As the WSJ piece notes, when North Shore-Long Island Jewish Health System took over Lenox Hill Hospital in 2010, the systems’s CMIO Michael Oppenheim had to bring Lenox Hill’s data to a new version of its Allscripts EMR.  The system used currently by Lenox Hill is an old one which isn’t certified for Meaningful Use.

Ultimately, hospitals’ urge to merge makes sense on a lot of levels. Given their tremendous capital costs (including EMR spending) it only makes sense to achieve economies of scale.  Unfortunately, the commonsense desire to save money and be more efficient is going to subject HIT leaders to an even rougher ride then they might have expected.

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June 14, 2013 I Written By

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

Filed Under: Certified EHR  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Hospitals  Meaningful Use
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Allscripts Drops Lawsuit Over $303 Million Deal

Allscripts has agreed to drop a lawsuit against the New York City Health & Hospitals Corp. over a $303 million contract, Bloomberg reports.  In a display of what may be wishful thinking, Allscripts said it “looks forward to having the opportunity to work with HHC on other matters in the future,” according to Bloomberg.

Allscripts had sued the Health & Hospitals Corp., which runs the city’s public hospitals, when it awarded an EMR contract to Epic Systems. The contract involved tying together 11 public hospitals, 70 clinics, thousands of doctors and more than one million patients.

Allscripts had argued that it was a more logical choice because among other things, it offered a less costly choice. Execs had estimated that over 15 years, when ancillary costs are included, it would cost $1.4 billion to implement Epic, while its own EMR rollout could be completed for less than half that number.

But Alan Aviles, HHC’s CEO, argued that his team had given plenty of consideration to Epic’s rivals, spending four years on its nine-vendor shortlist. Moreover, he didn’t buy Allscripts’ savings estimates, according to a New York Times piece. Aviles noted that Allscripts’ estimate had assumed that application support for its product would cost nothing for 15 years, while HHC estimated the cost at $357 million.

Well, I don’t know what good all of this legal fencing did Allscripts. The vendor is already under closer scrutiny than its peers, given its management troubles and continued rumors that it will be acquired. I’d argue that the last thing it needs is to dissipate executive energies on a lawsuit that makes it look unreasonable or even desperate. But at least its leaders had the sense to drop the suit and move on.

Now it can turn its energies to the MyWay suit filed against it by a group of Florida physicians. The suit claims that the MyWay EMR, which was taken off the market last year, was defective, and that the offer of a free upgrade to its professional suite imposed additional costs.

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March 27, 2013 I Written By

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

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Healthcare IT Market
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Big EMR Vendors Agree To Interoperability Scheme

John’s Comment: See my coverage of the CommonWell announcement on EMR and HIPAA.

Could it be that real interoperability between vendors is on the way? Five big EMR vendors — including three hospital-oriented giants and two doctor-focused players — have come together during HIMSS to announce plans to create common standards for health data sharing, reports Forbes.

Cerner, McKesson, Allscripts, athenahealth and Greenway Medical Technologies have joined to create a new non-profit called the CommonWell Health Alliance. (As most wags have noted, Epic is conspicuously absent from the mix.)

The partners haven’t disclosed a lot of detail as to how they plan to achieve interoperability amongst themselves, but the scheme seems to rely on creating a unique national ID. “Without a national ID and the ability to create true data that can be safely and securely sent between individuals, we are going to introduce new systemic risk back into the system,” Neal Patterson, founder, chairman and chief executive of Cerner told Forbes.

Patterson, public citizen that he is, said that the CommonWell Alliance isn’t a commercial effort but “an obligation.”  That certainly sounds lovely, but with five hyper-competitive public companies forming up this effort, I’m skeptical to say the least. Besides, if it’s an obligation, why isn’t Epic so obligated?

John Halamka, Chief Information Officer of Beth Israel Deaconness Medical Center in Boston, has probably sniffed out more of partners’ true motivation. “They’re thinking of it as an enabler for new technologies,” Halamka suggests to Forbes, a move which can “raise the tide for all boats.”

Whether it raises any boats or not, creating interoperability links between these vendors certainly can’t hurt. After all, the more data sharing the better, particularly by major players with significant market share.

That being said, there’s still the matter of Epic being out of the picture, not to mention other major EMR players. How much of a practical difference the CommonWell Health Alliance can make is very much in question.

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March 6, 2013 I Written By

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

Filed Under: EHR  EHR Market  Electronic Health Record  Electronic Medical Record  EMR  EMR Technology  Healthcare  Healthcare IT
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Allscripts (MDRX) Sued Over Discontinuing MyWay Support

A group of Florida doctors have filed what they hope will roll up into a nice, fat class action suit against Allscripts over the vendor’s discontinuing support for its medical practice-oriented MyWay system. The suit was filed by Panama City-based Pain Clinic of Northwest FL, which says it spent about $40,000 to implement MyWay.

The suit claims that MyWay is so flawed that some Allscripts customers haven’t been able to meet Meaningful Use standards using the system. That being said, dropping support left about 5,000 small group physicians who bought MyWay in a jam, it argues. The plaintiffs say the system Allscripts is offering as a free upgrade, EHR Pro, is more aimed at the needs of large practices.

Making things worse, EHR Pro really isn’t free, the Pain Clinic’s lawyers say. ”MyWay users – already unhappy with a defective product they paid enormous money to acquire, train and develop – must learn a new interface after spending so much time acclimating to the old system, and will continue to suffer the financial loss of the time and expense to re-train employees and migrate data, as well as the added cost to license and maintain a more complicated software program that exceeds the needs of most small physician practice groups,” the complaint says, according to a piece in the South Florida Business Journal.

In perhaps the most scandalous allegation, the clinic bringing the suit claims that Allscripts is asking for thousands of dollars in fees from users to release their data back to them if they don’t want to use EHR Pro. If this were true, it certainly wouldn’t do much for Allscripts’ reputation with potential medical group buyers; after all, nobody wants their clinical data held for ransom.

Whether or not the Florida pain clinic manages to pull together a large enough group to get certified as a class, if I were Allscripts I’d be careful with this one. It could end up as a PR debacle if nothing else.

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January 10, 2013 I Written By

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

Filed Under: EHR  EHR Market  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT  Healthcare IT Market  Meaningful Use
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Will Meaningful Use Affect M&A In The EMR Space?

As some of you may recall, Allscripts is said to be floating the possibility of selling out to a venture capital firm. This follows several months of tumult at the board level, including some who might have been helpful in keeping its merger with Eclypsis moving forward.

I’ve been thinking about this deal for a while, wondering whether it would come to fruition and if so, what would make it happen. And I’ve realized an Allscripts deal, or other EMR company sale, might give us a window into just how valuable Meaningful Use criteria have proven to be. Let me explain.

If I was a EMR vendor looking for an acquisition or merger, I’d certainly look at the usual metrics, including the customer list, code base my target had in house, maturity of the product line, the extent to which in-house programming talent could support the roadmap and so on. (Naturally, I’d go over its books in depth too.)

But that’s not all. These days we have some new perspectives from which to evaluate the success of EMR vendors, a set of standards which are fairly unique in the software business.  Two important examples: We can look at how successfully a vendor’s customers have been able to meet Meaningful Use goals to date, and how far along the HIMSS EMR Adoption Model customers are as well.

While both are interesting, Meaningful Use is more important, as it’s such a politically fraught, complicated and rapidly evolving set of standards. In short, I’d argue that if a vendor’s customers are doing well with MU, then it’s likely the vendor is doing something right.

Now, you can’t draw a straight line between the quality of a vendor’s product and how well its customers  have done in qualifying  for Meaningful Use. Implementation is ultimately the hospital or doctor’s responsibility, even if the provider pays for EMR vendor consulting to get things going. And there’s lots of ways things can go wrong that have little or nothing to do with the product.

Still, I predict that Meaningful Use success is going to become a more important metric in EMR vendor M&A as time goes by. After all, the more bragging rights a company has regarding Meaningful Use success, the more they can improve the acquiring vendor’s profile. That’s gotta matter.

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November 19, 2012 I Written By

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

Filed Under: EHR  EHR Market  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Healthcare IT Market  Meaningful Use
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EHR Incentives, Smart Bed Technology, and Remotoscope — #HITsm Chat Highlights

This weeks #HITsm chat was hosted by John, which was exciting to observe. If you’ve been keeping up with the different sites from Health Care Scene, some of these topics might seem similar. Be sure to tune in every Friday at noon EST, and join the conversation with #HITsm.

Topic One: A few in congress called for a halt on EHR incentives. Is this politics or something more? Are their observations founded? 

Topic Two: Allscripts is the 2nd EHR vendor to discontinue their small practice EHR (MyWay), is this a trend and what’s the impact of it? 

 Topic Three: Is the hospital bed the ultimate medical device monitor? What other med device monitors do you see on the horizon? 

Topic Four: What do you think of the remotoscope which allows you to diagnose ear infections at home using your iPhone? 

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October 13, 2012 I Written By

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

Filed Under: EHR  EHR Market  Electronic Health Record  Electronic Medical Record  EMR  EMR Adoption  EMR Technology  Healthcare  Healthcare IT  HIE  Meaningful Use  mHealth  PHR
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Allscripts May Sell Out To Private Equity Buyer

Update: You might be interested to read this post on Allscripts Plans to Discontinue MyWay.

Having just gone through the hell of a board gone wild, perhaps Allscripts’ leadership doubts it has the ability to govern.  Or maybe it’s just bracing for the fresh hells that EMR companies will face when the industry’s Big Consolidation begins (something we all know will happen, though not when). Either way, it seems that Allscripts is ready for a change in ownership.

Earlier this week, Bloomberg Businessweek reported that the company has retained Citigroup to explore selling out to a private equity buyer. According to published reports, Allscripts is considering a leveraged buyout, which would take it private but leave it holding a ton of debt. It sure must be eager to avoid scrutiny by curmudgeons on Wall Street!

At least one research type has already given such a move the thumbs up. According to Bloomberg Businessweek,  David Windley, an analyst with Jefferies & Co., the move makes sense despite the inherently high costs.  Allscripts “continues to climb a steep product integration hill that would be more comfortable out of the public eye,” the site quotes Windley as telling his clients.

Investors seem pleased with the  prospect of an Allscripts sale too. Shares of the company (MDRX) rose 14 percent when the news that Allscripts had tapped Citigroup hit the press last week.  Clearly, they don’t have complete confidence that the stock is headed for success as the company is constituted today.

There’s no doubt that Allscripts is on a challenging path in creating new, unified product offerings for a feverishly competitive market. The product integration effort Windley is referring to, and it’s a massive one, is the integration of Allscripts products with those of rival Eclipsys Corp., which it acquired in 2010.

Whether integration has been proceeding smoothly or not, it can’t have been a big confidence builder six months ago when Allscripts fired Chairman Phil Pead, who’d come on board when Eclipsys was purchased, and three board members resigned.

Plus, the rumors are swirling about Allscripts planning to sunset MyWay and move users to their Allscripts Professional product. More details on that change as it develops.

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October 5, 2012 I Written By

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

Filed Under: EHR  EHR Market  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT  Healthcare IT Market
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Are Large EHR Vendors More Likely to Shut Down an EHR Than Small EHR?

As most people who have read this blog for a while, you know that I try to bring you raw perspectives on things that a lot of people don’t want to talk about. Plus, I don’t mind arguing the other side of topics in order to provide a more well rounded view of an important topic. One of my main goals is to provide the information necessary for doctors to make great decisions.

I recently got into a lengthy discussion with someone about EHR vendor selection. They suggested that doctors should look to the 5 EHR market leaders in their EHR selection process (I believe he sold one of those EHR market leaders). He made some very good points about the market leaders ability to support all stages of meaningful use, that they have a solid business model that will support doctors for the long term, and that they have the resources to support an EHR software for the long run. He also provided some reasonable cautions around small EHR vendors with skeptical business models that might not be around a few years from now.

Certainly the points he makes have merit and are worthy of consideration. Although, unlike this person, I’m not so ready to throw the rest of the non-top 5 EHR vendors out and I think it’s a mistake for a doctor or practice manager to do so as well.

As I considered on this discussion, I realized that over the past 5-7 years, it’s many of the big EHR vendors that have closed up their EHR software. Possibly even more than the various startup EHR companies. Here are just a few examples of large companies shuttering their EHR: Misys (billion dollar company if I remember right), Epocrates and GE Centricity Advance (one of GE’s suite of EHR). Of course, Misys merged with Allscripts (if you call it a merger since they were going bankrupt), but I know a lot of unhappy Misys users that don’t know what to do now. GE has many other Centricity products as well and seems to have made a smoother transition for their Centricity Advance users. At least that’s within the same company. Epocrates is a large company, but didn’t have many EHR users.

My point of course is that even EHR software from large EHR vendors aren’t safe from possible future issues. In fact, I could make a reasonable case for why a smaller EHR vendor that’s grown in a sustainable way over a long period of time is in a better financial position than a HUGE company with a lot of overhead. Plus, I know personally A LOT of these small EHR vendor CEOs. They love what they’re doing and they’re in this for the long haul.

Now with 600+ EHR vendors out there, I’m certainly not saying that all of them have great business models. I was blown away when I met one at MGMA who had 1 doctor using their system. I hope whoever they sign up second is aware of the situation and is going in with both eyes open. There are certainly risks associated with being the second doctor on an EHR software, but there are also plenty of benefits as well. When you suggest something be changed, there’s a good chance you’ll get that change.

Conclusion
There are good small EHR companies.
There are good large EHR companies.
There are bad small EHR companies.
There are bad large EHR companies.

I guess what I’m saying is that size doesn’t matter in EHR selection. There are much more important factors to consider.

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May 9, 2012 I Written By

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

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT
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Allscripts (MDRX) Management Shakeup Spreading: Is Glen Tullman Next?

And Caesar’s spirit, raging for revenge,
With Ate by his side come hot from hell,
Shall in these confines with a monarch’s voice
Cry “Havoc!” and let slip the dogs of war,
– Julius Caesar, Act 3, Scene 1

If ever there was havoc in the boardroom of a health IT company, this is it. Over the last several days, chairman Phil Pead (bio still up for now), CFO William Davis and three board members unceremoniously and promptly departed the management team at Allscripts Healthcare (MDRX), a company which, it’s hard to argue, otherwise seems to have been on a reasonable course for the past year or so.

By the way, this seems to have been as much an Eclipsys purge as a board purge, as all of the departing members were with the company, which Allscripts acquired in September 2010 with “a vision for a Connected Community of Health.”

Within a few days, the Board announced that it had elected board member Dennis Chookaszian as Chairman. No word yet on which unlucky CFO will be hired to face the fires of investor displeasure over the stock’s performance (see below).

It’s bad enough when a chairman and three board members split — allegedly in support of now-ex chairman Phil Pead — but when your CFO leaves, a girl’s gotta wonder whether financial improprieties will turn up later. Now, let’s be clear, I’m not suggesting that there are ANY financial issues that I know of myself, directly, but it’s never a nice thing to see Mr. CFO shove off so quickly.

What we do know is that Allscripts was slapped with a suit in 2009 alleging the company broke federal securities laws when it went live with the latest version of its EMR. Current CEO Glen Tullman and now departed CFO William Davis were named as defendents. The  accusations in the 2009 suit seem to boil down to that Allscripts failed to let customers know that it couldn’t afford to install its Touchworks 11 software properly on customer sites.

It gets even better

And now, even more fun. Perhaps to contribute to the gladiatorial atmosphere, one of Allscripts’ largest shareholders demanded Monday April 30 that its chief executive Glen Tullman resign.  (If I were Tullman I’d say “the heck with that,” gather a group of investors and buy the darned thing out from under them. Mr. Tullman, go for it!)

Anyway, it seems that HealthCor Management LP, which owns about 5 percent of Allscripts outstanding shares, thinks execs have done a bad job building the value of the stock. The fund said the stock  is “being valued well below any reasonable acquisition price,” at its Friday close of $10.30.  Other investors seem to agree with HealthCor, as the stock went  up 7.73 percent to $11.10 at the close of trading on Monday April 30.

To make sure nobody panics, the company has hurriedly announced a $200 million stock repurchase  plan, adding to a plan announced a year ago which still contains $148 million for repurchase. That should do something to keep the stock from careening down a greased slide.

Why, oh why?

Now, to the real question. Why the big shakeup in the boardroom at a time when EMR/EHR companies are extremely vulnerable to market shifts and missteps? I can’t say I’ve found any concrete reason in my research, other than storied “differences of opinion over the direction of the company.”

The financials, while they could probably be much stronger, aren’t exactly pathetic. We’ve got a 5.1 percent profit margin, quarterly revenue growth year over year of 25.5 percent and a P/E (ttm, intraday) of 28.52.  The only obvious disappointment is the big drop in share price, which fell nearly 50 percent over the last 52 weeks of trading.

And in a somewhat ironic twist, it seems that Allscripts is touting some variant of the software Eclipsys had (Touchworks) when it first ran into SEC trouble.  Allscripts may not like the guys behind the technology, but it likes the technology for sure. (Actually, I’m eager to learn more what Allscripts is doing there — drop us a note on our contact us page if you have more information.)

P.S.  In the view of your friend and mine Mr. HISTalk, “No matter what explanations are provided, the casual observer might conclude that Glen (Tullman) staged a coup that cost the company four board members and its CFO at the worst possible time.” What do you think?

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May 1, 2012 I Written By

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

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  EMR Adoption  EMR Technology  Healthcare  Healthcare IT  Healthcare Social Media
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Will Hype Around the iPad 3 Lead to an Increase in EMR Apps?

In my conversations at HIMSS a few weeks ago with providers and vendors, I heard more than a few references to user-friendly EMR design, easy-to-use dashboards and the bar that has been set so high by Apple and the iPad. I had a chance to chat with David Carleton, VP and CIO at Heritage Valley Health System in Pennsylvania, about the adoption of the iPad in the clinical setting, particularly with regard to EMRs. Carleton, with the assistance of dbMotion, helped a team of docs and IT staff at HVHS in Pennsylvania develop their own EMR iPad app.

In a nutshell, the internet Clinical Access Portal (iCAP) app organizes and harmonizes data captured and stored in various systems – including its Allscripts Enterprise ambulatory solution and its soon-to-be-completed Allscripts Sunrise Clinical Manager, as well as the ClinicalConnect HIE in western Pennsylvania – and delivers Continuity of Care Documents (CCDs) to HVHS providers via the tablet. Named to the 2012 Top 100 Integrated Healthcare Networks, HVHS seems to be placing a high priority on enabling its facilities to be truly interoperable with one another. It made sense to me that the hospital would want to better enable its physicians with a handy iPad app, but I wondered why they took the in-house development route.

Carleton explained to me that one of the reasons was physician buy-in. (You can view more of our chat in the video below.) Apparently, the key to getting physicians to adopt and consistently use the tablet and app was to have them on board from the very beginning. Involvement in the design process let them have a say as to what would best fit their workflows.

With the release of the iPad 3, the details of which were announced yesterday, I’m willing to bet we’ll see an up tick in clinical interest in the iPad and a corresponding surge in app development – in-house or otherwise.

Are you aware of other facilities getting into the EMR app game? Please share the details in the comments below.

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March 8, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Filed Under: Electronic Medical Record  EMR  EMR Adoption  EMR and EHR Interviews  EMR and EHR Videos  EMR Technology  Healthcare IT  HIE  Hospitals
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