A little earlier this month American Medical News had an article about Costco selling EHR software. This doesn’t come as a big surprise since Walmart had been selling an EHR out of Sam’s Club for quite a while. Although, that program was discontinued shortly after the initial launch. Here’s a piece of the Allscripts MyWay EHR offering in Costco for those that missed it:

Costco has partnered with Etransmedia Technology to sell Allscripts MyWay EHR and practice management systems at Costco stores nationally. The store hopes physicians looking to collect incentive money for meaningful use of electronic medical records will take advantage of the deal.

Costco executive members can implement the integrated EMR/practice management system for $499 a month. For nonexecutive members, the price is $599 a month. The pricing is based on a 60-month contract, according to costcoehr.com, a website Etransmedia launched to promote the deal.

The Allscripts MyWay system offered by Costco is an integrated, Web-based EMR and practice management solution that includes e-prescribing, electronic claims and a patient portal. The monthly fee includes maintenance, support and hosting as well as online training. Allscripts advertises the EMR and PM systems separately on its website for $375 and $225, respectively, per full-time physician, per month.

Costco is not offering a deep discount for the systems, but the company said it is “simplifying the buying process” by offering a product it “carefully” selected.

Despite this having been done before, I’m still seeing a lot of people on social media sites that are asking why Costco would offer an EHR. The answer to me is simple: marketing. I remember reading the story of a practice that had gone through a thorough EHR selection process that was de-railed thanks to a Sam’s Club ad about EHR software. Something’s wrong with that practice in my opinion, but the reality of EHR sales is that the sale often hinges on the littlest thing. Even if that little thing is a Costco ad.

Yes, Costco EHR just doesn’t make sense, but when you consider it as a relatively inexpensive way to market your product to doctors, maybe it’s not that strange. Although, I could think of other more targeted ways to market EHR software.

While you’re at Costco purchasing your EHR, be sure to pick up a pack of those Fat Boy ice cream sandwiches. I’m sure they’ll make a great addition to your EHR implementation. It’s amazing what food will do to enhance staff morale.

I enjoyed all day at the EHR Summit that’s being held by HBMA in Phoenix. It’s been a really interesting event for me. I had some sound bites from the Ron Sterling keynote queued up, but it’s not connecting to Twitter. So, I’ll see if I can post those tomorrow. Today, I thought I’d post some of my other tweets from the other session. I think you’ll find them interesting, enlightening, thought provoking or some other adjective. I really look forward to the discussion on this post.

EMR software has many versions of the same data. #interesting #EHRSummit11 Think about an HIE as well. They have a version of the data too

HIE’s aren’t good at getting the receiving doctor the second version of a clinical document. #interesting #EHRSummit11

Think about the records retention issues when you switch EHR software companies. Good thought. #EHRSummit11

If you haven’t lost a client to a hospital this year….you will next year. #EHRSummit11 #HBMA

How many EHR companies are billing companies? They have 7 listed on screen. Do you know of others? #EHRSummit11
They have MED3000, Allscripts, Greenway, NextGen, Athena, GE Centricity, Ingenix. Any other EHR companies do billing as well? #EHRSummit11

Shame on you if you hire an EHR Company and don’t check the references. Ask for a list of 10 in that specialty and size. #EHRSummit11

Pre-existing conditions, No lifetime maximum and kids on parents plan for longer are going to increase our insurance costs. #EHRSummit11

Definitely interesting to consider how the healthcare billing industry will be affected by things like ACO’s and concierge. #EHRSummit11

Super bills are going to go away once we get ICD-10. #EHRSummit11 #HBMA

The healthcare billing sales cycle is 12-18 months. #EHRSummit11

Since I’m putting some of my tweets. I also enjoyed a number of the tweets coming out of the ONC Meeting today. Here’s one that really hit me:

RT @INHSbeacon If you’ve seen one CCD, you’ve seen one CCD. Everyone interprets different, we need to find a standard to succeed #ONCMeeting

I don’t know about you, but I’m not exactly sure what an Accountable Care Organization is. In fact, I’m betting nobody is — there’s a bunch of harrumphing and throat clearing out there, but I haven’t seen any crystal-clear descriptions out there.  Shall we say that ACOs are more honored in the breach than in the observance and leave it at that?

Now, we come to the puzzling part of this piece. If nobody’s managed to define an ACO clearly, how can any particular EMR be a better ACO tool than another?  We’ll have to ask KLAS about this one, since they’re the ones that discovered this “fact.”

Today, KLAS announced that it had interviewed 197 providers at 187 organizations to see how ACOs are forming up. A third of the respondents said that they were pursuing a formal Medicare ACO designation, and the majority were felt ACOs were the future, KLAS reported.

Sure, considering that ACOs are just risk-taking organizations with a capitated feel, some people already have a sense of what to expect. But throw an EMR into the mix and we’re in new territory — hopefully good territory, but new nonetheless.

So, tell me how providers know that Epic and Cerner are the most ACO-ready? Apparently, respondents believe that Cerner already has many of the IT pieces needed to run ACOs; moreover, they say Cerner is working closely with providers interested in the ACO model.

Survey takers also gave a nod to Epic, which they see as being close to ready (though behind in analyics and ability to share data with non-Epic users).

Wait a minute — let me get this straight.  Respondents know Cerner has the right pieces, even though the ACO doesn’t exist yet?  They like Epic, even though it doesn’t share data outside of its walled garden?  KLAS is kidding, right?

At this point, I’ll be kind and say that Epic and Cerner users are a bit brainwashed, which I too might be if I’d spent the kind of money those folks have on an EMR.

But the voice in my suggests that KLAS might have had its finger on the scales just a little bit. I will not publicly state that Allscripts, CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens scored worse because they didn’t pay for play…but something sure isn’t right here.

As any reader of this blog would know, there may be more EMR rankings out there than there are EMRs themselves. Of course, some lists are taken more seriously than others — KLAS comes to mind — but these days, with the money flowing, virtually everyone who can make a PDF is dipping an oar into the EMR ranking game.

The following list, from a a site called Business-Software.com, is particularly cute in that it would appear to be entirely bought and paid for by vendors — there’s nary a critical analysis to be found in the paper.  (Most of the lists I’ve seen at least pretend to be neutral.)

That being said, I still thought it might stimulate conversation among us to share the list.  I’d love to hear whether you think Business-Software.com has provided any value here, and whether you’ve had particularly good (or bad) experiences with listed EMR sellers.

Here’s Business-Software.com’s list, seemingly in no particular order. Where available there’s a link to get a demo/price quote from the vendors on the list courtesy of Medical Software Advice.

* AdvancedMD: Provides Web-based practice management, medical billing and scheduling software as well as an EMR. Includes a patient portal, e-prescribing and mobile access option.

*  Allscripts: Offers EHRs, practice management, revenue cycle management, document management, e-prescribing. Focuses on emergency department and care management systems for hospitals.

* Greenway: Offers EHR, integrated with practice management system, along with a database integrating clinical, financial and administrative data.

* Sage: Products include practice management, EHR, document and image management and point-of-care documentation.

* Aprima: Company offers EHR, practice management and revenue cycle management products, all aimed at medical practices.

* Kareo: Focuses on small medical practices. Key products include Web-based EHR, medical billing and practice management offerings.

* Abraxas Medical Solutions: Sells unified EMR and practice management solution. Product is powered by a single Microsoft-SQL database.

* Celerity Solutions Group: Provides EHR conversion and systems integration solutions to both large and small medical practices.

* NextGen Healthcare: Offers a very wide range of products, including EHRs for physicians, hospitals, health centers and healthcare providers, as well as practice management and financial management systems, HIE and patient portal options.

* meridianEMR: EMR focused specifically on urology specialists, as well as a product aimed at general surgery.

What bothers me about this list, by the by, is that while it’s almost certainly a series of advertisements, that’s not marked anywhere.

While physicians aren’t dummies by any means, my guess is that some might get sucked in by any list that says “top” in it if they’re feeling desperate enough.  Here’s hoping physicians catch on to the bias here.

It’s now official. Allscripts will be shutting down their PeakPractice EMR solution. In an FAQ for PeakPractice clients Allscripts gave more details. I’ve put a copy of the info below for reference. Honestly, this wasn’t much of a surprise for me. Allscripts had far too many EMR software in one company. It seems that Allscripts has chosen to go with: MyWay, Professional and MedFlow as their EMR packages going forward.

I do find it interesting that Allscripts plans to support PeakPractice through the first stage of meaningful use. I think the time frames were just too small to do otherwise. If there was a bit more time it would have made sense for Allscripts to use the stimulus money to motivate people to move off of PeakPractice and on to one of the other Allscripts EMR.

I’m honestly interested to hear how well the conversion goes between PeakPractice and other Allscripts EMR solutions. I think there’s going to be a lot of misinformation about what the can and can’t convert. Especially since it seems like what they’ll be able to convert will depend on which Allscripts EMR software you choose to convert to. Yeah, this has mess written all over it.

I’ll be watching for the next round of companies that take care of EMR conversions from PeakPractice. I remember the round when all the Misys users were ready to convert from Misys to something other than Allscripts. I expect we’ll see similar movement by PeakPractice EMR users. So much for going with a large company to ensure the stability of your EMR software.

Here’s the letter from Allscripts to PeakPractice Users:

Dear Valued PeakPractice Client,

When we brought together Allscripts and Eclipsys, we committed to you that we would share critical decisions as soon as they were complete.

After careful deliberation and review, we are making a change to our future plans for PeakPractice. In making this decision, our goal was to ensure that we could effectively meet your needs both now and in the future by providing you with systems that are stable, easy to support, and flexible enough to allow us to quickly respond to the rapidly changing market and regulatory requirements.

After careful analysis, we have decided to make the following changes.

We will continue development of the current version (5.5) of PeakPractice and ensure that it achieves ARRA Certification as a Complete EHR. We will be submitting this version for certification later in October. This will allow you, as a current PeakPractice client, to use the certified version to demonstrate Stage 1 Meaningful Use and claim your 2011 Stimulus incentives. With this version, you will be eligible for the first two years of incentives for Stimulus, totaling $30,000 under the Medicare program ($18,000 in year 1 and $12,000 in year 2).

We will continue development to ensure PeakPractice’s compliance with ANSI 5010, which will be released as PeakPractice version 5.6.

We will continue to provide support and hot fixes as needed for PeakPractice for the foreseeable future.
Relative to future versions, we will not develop net new features for PeakPractice once ARRA certification and ANSI 5010 compliance are achieved.

We will offer an upgrade path that includes both a FREE like-for-like, license-for-license swap and a FREE data conversion (see below) for current PeakPractice clients who want to upgrade to another Allscripts solution. We expect that many of our clients will choose to wait to upgrade until after you demonstrate Meaningful Use in 2011 with PeakPractice and receive your Stimulus incentives.

We have set up a PeakPractice Hotline at 877-611-1377 to both answer questions and arrange an assessment as to which Allscripts EHR/PM platform will be best for your organization.

We will work with you to determine the product and timeline that is designed to be most effective for you and have the least impact on your operations. We would encourage you to consider scheduling an upgrade to your EHR/PM solution at a time that is best for you, again, most likely after you have demonstrated Meaningful Use in 2011.

In terms of the upgrade we are making available, we will provide the following.

A FREE like-for-like, license-for-license swap between PeakPractice and a corresponding Allscripts EHR and/or PM solution (MyWay, Professional or MedFlow, depending upon your needs). We recognize there are many complexities surrounding the combinations of Practice Management and EHR products, but our program addresses each of these in detail.

We will convert data from your PeakPractice system to the selected Allscripts solution for FREE. Again, the scope of what will be converted varies depending on the systems from which and to which you are migrating.

Please note that while templates are not included in this conversion, we can recommend resources that can assist with template conversions, if you wish to pursue them. Likewise, other services (such as ASP fees, support, set-up, hosting, and EDI, such as through Payerpath) are available for the Allscripts products, but are not part of the free upgrade. We will be happy to discuss how to arrange for those services with you. This free upgrade is available through December 31, 2012. This should give everyone ample time to decide which route they wish to pursue.

We do not make this change lightly, as we recognize and appreciate the investment that you have made in this solution.
You will likely have many questions about this process, and we hope this link to our Frequently Asked Questions document addresses many of them. If you have further questions, please call the PeakPractice hotline (877-611-1377) or your Allscripts representative.

We intend to provide you with a pathway that allows you to achieve all stages of Meaningful Use and protects the investment you have made. We are committed to working with you as partners during and after this transition.

Today, it was announced that Allscripts will acquire Eclipsys for $1.3 billion. This is a really big move and not all that unexpected. We knew that consolidation was coming and for that matter it’s going to keep happening. However, this is a very large merger that has a lot of questions. Allscripts and Eclipsys have created a new site for the acquisition.

Here’s a video of Glen Tullman talking about the acquisition of Eclipsys:

The comments made on the HISTalk post about the merger were really interesting. Here’s just a few:
From NYC EMR:
Allscripts hosted a meeting Monday showing integration options with Eclipsys with some of their mutual clients (NYP, Lahey, etc). This didn’t go well for Allscripts, clients dont like the product and hate the integration obtions. One client calling it an abortion, one other saying it is a good attempt but falls short. They also commented negatively on AllScripts management saying they sell well, but can’t execute. Privately the clients me and to a tee they said Eclipsys new release is what they want with more content, but that AllScripts is well off the mark for a go-forward Ambulatory solutoin. Hopefully Eclipsys will continue to build out thier solution instead of some hokey integration story that Allscripts is touting to make up for their lack of an acute care offering. Does anyone else know anything about this?

From Not Happy:
“Eclipsys, you have over 20 million a year from a client and what did that go to? No enterprise revenue cycle product, 50 million for Bond and Medinotes? Now the investment goes towards 5 plus ambulatory and HIE products? Merger has WAY too many products for the same markets- Ambulatory alone has Mysis, allscripts touchworks, allscripts professional, Eclipsys sunrise amb, Eclipsys peak (bond clinician), and Medinotes.”. Forest Gump take away- RUN, RUN, RUN

From Lazlo Holyfeld:
Smorgasbord. My bet is that Sunset Ambulatory and MyWay get sunsetted in the end. Allscripts has Peak Practice for the small practices while keeping Professional & Enterprise for the big clients. Allscripts did waste some R&D funds on trying to update the source from Aprima to bring MyWay up-to-speed this year especially on the coding/billing side. In the end, it is still a pig with lipstick on it. If you really want MyWay, you are better off with Aprima (iMedica).

As for the HIE aspect, that is the harder part of this to guess what plays ot. Allscripts has several parternships with various HIE vendors but dbMotion is their contracted partner. If a client doesn’t want dbMotion, they have to have a seperate agreement.

More interesting to see what happens with the Eclipsys relationships with Medicity & Microsoft. Less clear on what happens there.

Matthew Holt of the healthcare blog always does a nice job with his interviews. This is a pretty interesting one with Glen Tullman, CEO of Allscripts. Like it or not, Allscripts is going to play a big part in the EMR/EHR space. So, it’s worth listening to Glen to hear what he has to say about the industry.

One part that I found especially interesting was when he calls out Epic for not working on EMR interoperability. What’s interesting is that Glen really did look sincere in his desire for Allscripts to be inter operable. The problem is that I haven’t seen enough action in implementing those solutions.

Lots of other goodies in the video as well. Nice work Matthew.

I found this about a week ago and found it really really interesting. Here’s the numbers for the EMR behemoth Allscripts per HIT News:

The company [Allscripts] made $15.8 million in net income for the quarter, turning around a $6 million loss for the same period last year. Non-GAAP net income increased 45 percent, from $16.6 million a year ago to $24 million this year.

The sad part is that Allscripts went through a nice round of layoffs last year. I can’t find the number right now, but I remember it was pretty significant. Too bad they had to fire so many people while turning such a large profit. Seems like an opportunistic cut to me. I wonder how well Allscripts support was with all the cuts.

Another quote from the same article:

“We believe that 2010 will be the ‘Year of the EHR’ in which we expect to see significant acceleration in the adoption and utilization of healthcare information technology to improve quality and reduce cost,” said Glen Tullman, Allscripts CEO. “This is a once-in-a-lifetime market opportunity, driven by the American Recovery and Reinvestment Act.”

There’s no doubt that Glen Tullman is salivating over the $18 billion of EMR stimulus money that’s on the table. He probably should be since Allscripts is likely to make a killing off of the stimulus money.

I think all of this is also a very good sign for smaller EMR vendors as well. I expect a number of EMR vendors to scale to 500 or so installs and sell off for a very nice return in the next few years. I guess we’ll see if Glen’s right about this being the “Year of the EHR.”

This is an interesting press release about connecting 7,000 physicians and 13 hospitals EHR systems together. Although, the most glaring part is the $400 million it will take to make it happen. Here’s the press release:

“The North Shore-LIJ Health System announced today it is subsidizing up to 85 percent of the cost of implementing and operating an Electronic Health Records (EHR) system in the offices of its more than 7,000 affiliated physicians in New York City and Long Island — part of a $400 million investment to strengthen the quality of care throughout the region by automating inpatient and outpatient records in all medical settings, including 13 hospitals. In implementing the largest EHR program in the New York metropolitan area and one of the largest in the nation, North Shore-LIJ will provide physicians with individual subsidies of up to $40,000 over five years.”

Michael J. Dowling, president and chief executive officer (CEO) of the North Shore-LIJ Health System said “We’re not going to measure our return-on-investment (ROI) in terms of dollars and cents; our ROI will be based on our ability to improve patient outcomes.”

“Glen Tullman, CEO of Allscripts, noted that providing physicians with real-time care guidelines via the EHR increases the probability of achieving fundamental improvements in the quality of patient care.”

John Bosco, North Shore-LIJ’s chief information officer said “the Allscripts’ EHR will connect to a separate inpatient clinical information system from Eclipsys Corporation that North Shore-LIJ is deploying at its hospitals and other facilities.”

I just ran into a Urologist who purchased an EMR. His group decided to get Allscripts because they knew Urologists who liked it. They also heard that Allscripts had very good support.

I have heard that Allscripts’ EMR is not very user-friendly. Their ePrescribing solution is well liked, but from my reading of the blogs, their EMR is not well liked.

Does anyone use Allscripts EMR? How do you like it?