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!

Health System Sues Cerner Over Billing-Related Losses

Posted on October 5, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If I asked you what issues cause the biggest conflicts between EMR vendors and their clients, you might guess that clinical data management disputes or customer service issues topped the list. But actually, in my experience the most common problems health systems encounter in their EMR rollouts are billing-related.

For example, Dana-Farber Cancer Institute just announced a $44.2 million operating loss for the third quarter of fiscal 2017. The Boston-based hospital attributes at least part of its losses to billing issues associated with its Epic system. Leaders at Dana-Farber said that these billing issues had cost the hospital roughly $25 million since it rolled out Epic in May 2015, according to Becker’s Hospital CFO Report.

Another instance comes from Healthcare IT News, which reports that Cerner is being sued by a health system accusing the vendor of selling it faulty billing software.

The suit, by Wisconsin-based Agnesian Healthcare, accuses Cerner of fraud and breach of warranty, and asserts that issues with Cerner’s revenue cycle software led to losses of more than $16 million. The hospital system contends that these problems have damaged its reputation and generated $200,000 a month in damages. (Cerner disputes these allegations, of course.)

According to HIN, the hospital system went live with Cerner’s RCM software in 2015, for which it paid $300,000. Agnesian’s suit says that problems with the Cerner package began shortly after rollout, generating widespread errors in its patient billing statements.

According to the health system, its billing process was so compromised that it had to send out statements by hand. (Yes, I can feel you cringing from here.) Given the delays inherent in relying on manual processes, Agnesian ended up with a huge backlog of unprocessed statements, some of which it deemed uncollectible and wrote off.

When the health system alerted Cerner about its concerns, the vendor got involved, and in 2016 it told Agnesian that problems have been addressed.  Nonetheless, this year the health system found “major additional coding errors” which led to another round of lost revenue, Agnesian says.

And brace yourself for more cringing: according to the suit, the Cerner RCM software had been writing off reimbursable charges without informing the health system. If you’re an RCM leader or CFO, this is the stuff of nightmares.

Ultimately, Cerner agreed that the RCM solution needed to be rebuilt given the depth of the coding errors found in the software, but that didn’t happen, the suit says. In a final indignity, the personnel tasked with rebuilding the RCM solution left Cerner before completing the rebuild.

Given all the aforementioned mishegas, it will be many a month before billing processes normalize even if Cerner fixes its RCM software, the health system says. And of course, it’s likely to end up writing off more bills under the circumstances, which has got to be very painful by this point.

Agnesian’s suit asks the court to cancel the Cerner contract and award it direct, indirect and punitive damages. Cerner, meanwhile, seems to want to go into arbitration. We’ll see which side blinks first.

Mental Health EMRs And MIPS – MACRA Monday

Posted on September 18, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

Recently, I began researching the mental health EMR market on behalf of a client. I had expected to find it dwindling as a) the big EMR players have always insisted that an all-purpose EMR could be adapted to serve mental health providers effectively and b) more importantly because mental health professionals weren’t eligible for Meaningful Use payments, which presumably made them lousy sales targets for vendors.

However, my research concluded that there’s roughly a dozen mental health EMRs out there and kicking and that at least two large medical EMR vendors had bought into the mental health technology niche. (Allscripts bought a stake in NetSmart Technologies last year, and Cerner acquired Anasazi outright in 2012). With their investments, the two vendors effectively admitted that supporting mental health providers wasn’t as easy as they’d suggested.

Now, with MIPS imposing new demands on clinicians, mental health providers are likely to expect even more from mental health IT vendors, said Bob Ring, a consultant with Mica Information Systems.

Right now, few mental health EMRs defining themselves as “therapy specific” are CEHRT technology, which could become an issue if MDs on staff in a mental health setting want to meet MIPS requirements, Ring notes.

Under MIPS, psychiatrists must provide a wide range of mental health-specific data, some of which calls for specialty-related technology. For example, one category under the Clinical Practice Improvement Activity Performance Category calls for enhancements to an EMR to capture added data on behavioral health populations and use that data for additional decision-making.

But uncertified EMRs are likely to stay that way, Ring says. “Because these therapy-specific [EMRs] are generally priced very low, and it is expensive to go through the ONC certification process, it’s questionable whether many of them ever will be,” he concludes.

Not only that, things could get even trickier for both mental health clinicians and mental health EMR vendors in the future, if CMS follows through on its threat to hold therapists to the same standards as MDs beginning in 2019.

This could create chaos, however, according to my colleague John Lynn, who contends that putting mental health therapy EMRs under MIPS would be “a disaster.” Instead, mental health should not piggyback MU or MIPS, but instead, focus on incentives for mental health focused EHR incentives.

“The relationship between a mental health provider and a client is totally different than the relationship between a medical provider and their patient,” said John, whose first EMR implementation came when he rolled out a medical EMR in a health and counseling center. “Their methods of documentation are different. Their methods of billing are different. Their approach to care is different. We made it work, but it took a lot of duct tape and jerry rigging to fit it in.”

USAA Tapping EHR To Gather Data From Life Insurance Applicants

Posted on August 10, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I can’t believe I missed this. Apparently, financial giant USAA announced earlier this year that it’s collecting health data from life insurance applicants by interfacing with patient portals. While it may not be the first life insurer to do so, I haven’t been able to find any others, which makes this pretty interesting.

Usually, when someone applies for life insurance, they have to produce medical records which support their application. (We wouldn’t want someone to buy a policy and pop off the next day, would we?) In the past, applicants have had to push their providers to send medical records to the insurer. As anyone who’s tried to get health records for themselves knows, getting this done can be challenging and is likely to slow down policy approvals.

Thanks to USAA’s new technology implementation, however, the process is much simpler. The new offering, which is available to applicants at the Department of Veterans Affairs and Department of Defense, allows consumers to deliver their health data directly to the insurer via their patient portal.

To make this possible, USAA worked with Cerner on EHR retrieval technology. The technology, known as HealtheHistory, supports health data collection,  encrypts data transmission and limits access to EHR data to approved persons. No word yet as to whether Cerner has struck similar deals elsewhere but it wouldn’t surprise me.

USAA’s new EHR-based approach has paid off nicely. The life insurer has seen an average 30-day reduction in the time it takes to acquire health records for applicants, and though it doesn’t say what the average was back in the days of paper records, I assume that this is a big improvement.

And now on to the less attractive aspects of this deal. I don’t know about you, but I see a couple of red flags here.

First, while life insurers may know how to capture health data, I doubt they’re cognizant of HIPAA nuances. Even if they hire a truckload of HIPAA experts, they don’t have much context for maintaining HIPAA compliance. What’s more, they rarely if ever have to look a patient in the face, which serves as something of a natural deterrent to provider data carelessness.

Also, given the industry’s track record, is it really a good idea to give a life insurer that much data? For example, consider the case of a healthy 36-year-old woman with no current medical issues who was denied coverage because she had the BRCA 1 gene. That gene, as some readers may know, is associated with an increased risk of breast and ovarian cancer.

The life insurer apparently found out about the woman’s makeup as part of the application process, which included queries about genetic information. Apparently, the woman had had such testing, and as a result had to disclose it or risk being accused of fraud.

While the insurer in question may have the right, legally, to make such decisions, their doing so falls into a gray area ethically. What’s more, things would get foggier if, say, it decided to share such information with a sister health insurance division. Doing so may not be legal but I can easily see it happening.

Should someone’s genes be used to exclude them life or health insurance? Bar them from being approved for a mortgage from another sister company? Can insurers be trusted to meet HIPAA standards for use of PHI? It’ll be important to address such questions before we throw our weight behind open health data sharing with companies like USAA.

Researcher Puts Epic In Third Place For EMR Market Share

Posted on May 16, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new research report tracking market share held by EMR vendors puts Epic in third place, behind Cerner and McKesson, a conclusion which is likely to spark debate among industry watchers.

The analyst firm behind the report, Rockville, MD-based Kalorama Information, starts by pointing out that despite the hegemony maintained by larger EMR vendors, the competition for business is still quite lively. With customers still dissatisfied with their systems, the hundreds of vendors still in the market have a shot at thriving, it notes.

Kalorama publisher Bruce Carlson argues that until the larger firms get their act together, there will still be plenty of opportunity for these scrappy smaller players: “It’s still true to say no company, not even the largest healthcare IT firms, have even a fifth of this market,” Carlson said in a published statement. “We think that is because there’s still usability, vendor-switching, lack of mindshare in the market and customers are aching for better.”

In calculating how much each vendor has of the EMR market, the analyst firm estimated each vendors’ hardware, software and services revenue flowing directly from EMRs, breaking out the percentage each category represented for each vendor. All projects were based on 2016 data.

Among the giants, Kalorama ranks Cerner as having the biggest market share, McKesson as second in place and Epic as third. The report’s observations include:

  • That Cerner is picking up new business, in part, due to the addition of its CernerITWorks suite, which works with hospital IT departments, and Cerner RevWorks, which supports revenue cycle management functions. Kalorama also attributes Cerner’s success to the acquisition of Siemens IT and its having won the Department of Defense EMR contract.
  • That McKesson is building on its overall success as a health IT vendor, which puts it in a good position to build on its existing technology. For example, it has solutions addressing medication safety, information access, revenue cycle management, resource use and physician adoption of EMRs, including Paragon, Horizon, EHRM, Star and Series for hospitals, along with Practice Partners, Practice Point Plus and Fusion for ambulatory care.
  • That Epic serves giant customers like Kaiser Permanente, as well as holding a major share of new business in the EMR market. Kalorama is predicting that Epic will pick up more ambulatory customers, which it has focused on more closely of late.

The report also lists Allscripts Healthcare Solution, which came in fourth. Meanwhile, it tosses in GE Healthcare, Athenahealth’s Intersystems, QSI/NextGen, MEDITECH, Greenway and eClinicalWorks in with a bundle of at least 600 companies active in the EMR market.

The report summary we editors got didn’t include some details on how the market components broke down. I would like to know more about the niches in which these vendors play.

For example, having seen a prediction earlier this year that the physician practice market would hit $17.6 billion worldwide within seven years, it would be interesting to see that dot connected with the rest of the market share information. Specifically, I’d like to know how much of the ambulatory EMR market included integrated practice management software. That would tell me something about where overall solutions for physicians were headed.

However, I still got something out of the information Kalorama shared.  As our esteemed publisher John Lynn often notes, all market share measurements are a bit, um, idiosyncratic at best, and some are not even that reliable. But as I see it the estimates are worth considering nonetheless, as they challenge us to look at the key moving parts in the EMR market. Hey, and it gives us something to talk about at tradeshow parties!

Epic Launches FHIR-Based App Platform

Posted on March 2, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It looks like Epic is getting on the FHIR train. According to an article in Modern Healthcare, Epic is launching a new program – serving physician practices and hospitals – to help them build customized apps. The program, App Orchard, will also support independent mobile app developers who target providers and patients.

The launch follows on the heels of a similar move by Cerner, which set up its own sandbox for developers interested in linking to its EMR using FHIR. The Cerner Open Developer Experience (code_), which launched in early 2016, is working with firms creating SMART on FHIR apps.

App Orchard, for its part, lets developers use a FHIR-based API to access an Epic development sandbox. This will allow the developers to address issues in connecting their apps to the Epic EMR. Previously, Epic wouldn’t let mobile app developers connect to its EMR until a customer requested permission on their behalf.

In addition to providing the API, App Orchard will also serve as an online marketplace along the lines of Google Play or the Apple app store. However, end users won’t be able to download the app for their own use — only software developers and vendors will be able to do that. The idea is that these developers will create the apps on contract to customers.

Meanwhile, according to the magazine, Epic will screen and pick an initial group of developers to the program. Brett Gann, who leads the Epic-based team developing App Orchard, told Modern Healthcare that factors which will distinguish one developer from the other include app safety, security, privacy, reliability, system integrity, data integrity and scalability.

As part of their participation, developers will get documentation listing these criteria and what they mean to Epic. The Epic team will expect the developers to commit to following these guidelines and explain how they’ll do so, Gann said.

While Epic hasn’t made any predictions about what types of apps developers will pursue, recent research offers a clue. According to new research by SMART and KLAS, providers are especially interested in apps that help with patient engagement, EMR data viewing, diagnostics, clinical decision support and documentation tasks.

One thing to watch is how Epic decides to handle licensing, ownership, and charges for participation in their Orchard Program. If they have a true open API, then this will be a good move for the industry. If instead they choose to take ownership of everything that’s created, put restrictive licenses on developers, and/or charge huge sums to participate, then it’s unlikely to see much true innovation that’s possible with an open API. We’ll see how that plays out.

Meanwhile, in other Epic news, Becker’s Hospital Review notes that the vendor is planning to develop two additional versions of its EMR. Adam Whitlatch, a lead developer there, told the site that the new versions will include a mid-range EMR with fewer modules (dubbed “utility”), and a slimmer version with fewer modules and advanced features, to be called “Sonnet.”

Whitlatch said the new versions will target physician practices and smaller hospitals, which might prefer a lower-cost EMR that can be implemented more quickly than the standard Epic product. It’s also worth noting that the two new EMR versions will be interoperable with the traditional Epic EMR (known as “all-terrain”).

All told, these are intriguing developments which could have an impact on the EMR industry as a whole.

On the one hand, not only is Epic supporting the movement towards interchangeable apps based on FHIR, it appears that the vendor has decided to give in to the inevitable and started to open up its platform (something it hasn’t done willingly in the past).  Over time, this could affect providers’ overall Epic development plans if Epic executes it well and enables innovation on Orchard and doesn’t restrict it.

Also, the new versions of the Epic could make it available to a much wider audience, particularly if the stripped-down versions are significantly cheaper than its signature EMR. In fact, an affordable Epic EMR could trigger a big shakeup in the ambulatory EMR market.

Let’s see if more large EMR vendors decide to offer an open API. If access to EMR APIs became common, it would represent a major shift in the whole health IT ecosystem.

Rival Interoperability Groups Connect To Share Health Data

Posted on December 27, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Two formerly competitive health data interoperability groups have agreed to work together to share data with each others’ members. CommonWell Health Alliance, which made waves when it included Cerner but not Epic in its membership, has agreed to share data with Carequality, of which Epic is a part. (Of course, Epic said that it chose not to participate in the former group, but let’s not get off track with inside baseball here!)

Anyway, CommonWell was founded in early 2013 by a group of six health IT vendors (Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth.) Carequality, for its part, launched in January of this year, with Epic, eClinicalWorks, NextGen Healthcare and Surescripts on board.

Under the terms of the deal, the two will shake hands and play nicely together. The effort will seemingly be assisted by The Sequoia Project, the nonprofit parent under which Carequality operates.

The Sequoia Project brings plenty of experience to the table, as it operates eHealth Exchange, a national health information network. Its members include the AMA, Kaiser Permanente, CVS’s Minute Clinic, Walgreens and Surescripts, while CommonWell is largely vendor-focused.

As things stand, CommonWell runs a health data sharing network allowing for cross-vendor nationwide data exchange. Its services include patient ID management, record location and query/retrieve broker services which enable providers to locate multiple records for patient using a single query.

Carequality, for its part, offers a framework which supports interoperability between health data sharing network and service providers. Its members include payer networks, vendor networks, ACOs, personal health record and consumer services.

Going forward, CommonWell will allow its subscribers to share health information through directed queries with any Carequality participant.  Meanwhile, Carequality will create a version of the CommonWell record locator service and make it available to any of its providers.

Once the record-sharing agreement is fully implemented, it should have wide ranging effects. According to The Sequoia Project, CommonWell and Carequality participants cut across more than 90% of the acute EHR market, and nearly 60% of the ambulatory EHR market. Over 15,000 hospitals clinics and other healthcare providers are actively using the Carequality framework or CommonWell network.

But as with any interoperability project, the devil will be in the details. While cross-group cooperation sounds good, my guess is that it will take quite a while for both groups to roll out production versions of their new data sharing technologies.

It’s hard for me to imagine any scenario in which the two won’t engage in some internecine sniping over how to get this done. After all, people have a psychological investment in their chosen interoperability approach – so I’d be astonished if the two teams don’t have, let’s say, heated discussions over how to resolve their technical differences. After all, it’s human factors like these which always seem to slow other worthy efforts.

Still, on the whole I’d say that if it works, this deal is good for health IT. More cooperation is definitely better than less.

Accountable Care HIT Spending Growing Worldwide

Posted on November 30, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new market research report has concluded that given the pressures advancing the development of accountable care models, the market for solutions serving ACOs should expand worldwide, though North America is likely to lead the segment for the near future.

The report, by research firm Markets & Markets, covers a wide range of technologies, including EHRs, healthcare analytics, HIE, RCM, CDSS, population health, claims management and care management. It also looks at delivery mode, e.g. on premise, web and cloud and end-user, which includes providers and payers. So bear that in mind when you look at these numbers. That being said, providers accounted for the largest share of this niche last year, and should see the highest growth in the sector over the next five years.

Broadly speaking, Markets & Markets reports that the accountable care solutions market grew a healthy growth rate during the last decade. Researchers there expect to see this market grow at a CAGR of 16.6% over the next five years, to hit $18.86 billion by 2021.

When it comes to leaders in the sector, researchers identify Cerner, IBM, Aetna and Epic as leaders in the current ACO solutions market and probable future winners between 2016 and 2021. Other major players in the space include UnitedHealth Group, Allscripts, McKesson, Verisk Health, Zeomega, eClinicalWorks and NextGen. Given how broadly they define this category, I’m not sure how important this is, but there you have it.

According Markets & Markets, the growth of the ACO solutions market worldwide is due to forces we know well, including shifting government regulations, the rollout of initiatives shifting financial risk from payers to providers, the demand to slow down healthcare cost increases in the advance of IT and big data capabilities. (Personally, I’d add the desire of health systems – ACO-affiliated or not – to differentiate themselves by performing well at the population health level.)

If your view is largely US-centric, as is mine, you might be interested to note that the trend towards ACO-like entities in the Asia-Pacific and Latin American regions is expanding, the researchers report. Most specifically, Markets & Markets researchers found that there is notable growth occurring in Asian countries, which, it reports, are modifying regulations and monitoring the implementation of procedures, policies and guidelines to promote innovation and commercialization. This has led to an increasing number of hospitals and academic institutions interested in the sector, along with a government focus on implementing health IT solutions and infrastructure – factors likely to generate an expanding ACO solutions market there.

After reading all of this, the question I’m left with is whether there’s any point in differentiating an “ACO” specific player as these researchers have. Maybe I’m playing with words too much hear, but wouldn’t it be more accurate to say that the definition of health system infrastructure is evolving, whether it’s part of an ACO as such or not?

News Flash: Physicians Still Very Dissatisfied With EMRs

Posted on October 18, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Anyone who reads this blog knows that many physicians still aren’t convinced that the big industry-wide EMR rollout was a good idea. But nonetheless, I was still surprised to learn — as you might be as well — that in the aggregate, physicians thoroughly dislike pretty much all of the ambulatory EMRs commonly used in medical practices today.

This conclusion, along with several other interesting factoids, comes from a new report from healthcare research firm peer60. The report is based on a survey from the firm conducted in August of this year, reaching out to 1,053 doctors in various specialties.

Generally speaking, the peer60 study found that EMR market for acute care facilities is consolidating quickly, and that Epic continues to add market share in the ambulatory EMR market (Although, it’s possible that’s also survey bias).  In fact, 50% of respondents reported using an Epic system, followed by 21% Cerner, 9% Allscripts and 4% the military EMR VistA.  Not surprisingly, respondents reporting Epic use accounted for 55% of hospitals with 751+ beds, but less predictably, a full 59% of hospitals of up to 300 beds were Epic shops as well. (For an alternate look at acute care EMR market share, check out the stats on systems with the highest number of certified users.)

When it came to which EMR the physician used in their own practice, however, the market looks a lot tighter. While 18% of respondents said they used Epic, 7% reported using Allscripts, 6% eClinicalWorks, 5% Cerner, 4% athenahealth, e-MDs and NextGen, 3% Greenway and Practice Fusion and 2% GE Healthcare. Clearly, have remained open to a far greater set of choices than hospitals. And that competition is likely to remain robust, as few practices seem to be willing to change to competitor systems — in fact, only 9% said they were interested in switching at present.

To me, where the report got particularly interesting was when peer60 offered data on the “net promoter scores” for some of the top vendors. The net promoter score method it uses is simple: it subtracts the percent of physicians who wouldn’t recommend an EMR from the percent who would recommend that EMR to get a number from 100 to -100. And obviously, if lots of physicians reported that they wouldn’t recommend a product the NPS fell into the negative.

While the report declines to name which NPS is associated with which vendor, it’s clear that virtually none have anything to write home about here. All but one of the NPS ratings were below zero, and one was rated at a nasty -73. The best NPS among the ambulatory care vendors was a 5, which as I read it suggests that either physicians feel they can tolerate it or simply believe the rest of the crop of competitors are even worse.

Clearly, something is out of order across the entire ambulatory EMR industry if a study like this — which drew on a fairly large number of respondents cutting across most hospital sizes and specialties — suggests that doctors are so unhappy with what they have. According to the report, the biggest physician frustrations are poor EMR usability and a lack of desired functionality, so what are we waiting for? Let’s get this right! The EMR revolution will never bear fruit if so many doctors are so frustrated with the tools they have.

Integrating With EMR Vendors Remains Difficult, But This Must Change

Posted on October 4, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Eventually, big EMR vendors will be forced to provide a robust API that makes it easy to attach services on to their core platform. While they may see it as a dilution of their value right now, in time it will become clear that they can’t provide everything to everyone.

For example, is pretty unlikely that companies like Epic and Cerner will build genomics applications, so they’re going to need to connect using an API to add that functionality for their users. (Check out this video with John Lynn, Chris Bradley of Mana Health and Josh Siegel of CareCloud for more background on building a usable healthcare API.)

But as recent research points out, some of the vendors may be dragged kicking and screaming in that direction before they make it easy to connect to their systems. In fact, a new study by Health 2.0 concludes that smaller health IT vendors still face significant difficulties integrating with EMRs created by larger vendors.

“The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors,” wrote Health 2.0’s Matthew Holt on The Health Care Blog. “Most EMR vendors don’t make it easy.”

The study, which was supported by the California Health Care Foundation, surveyed more than 100 small health technology firms. The researchers found that only two EMR vendors (athenahealth and Allscripts) were viewed by smaller vendors as having a well-advertised, easy to access partner program. When it came to other large vendors, about half were happy with Epic, Cerner and GE’s efforts, while NextGen and eClinicalWorks got low marks for ease of integration, Holt reported.

To get the big vendors on board, it seems as though customer pressure is still critical at present, Holt says. Vendors reported that it helped a great deal if they had a customer who was seeking the integration. The degree to which this mattered varied, but it seemed to be most important in the case of Epic, with 70% of small vendors saying that they needed to have a client recommend them before Epic would get involved in integration project.

But that doesn’t mean it’s smooth sailing from there on out.  Even in the case where the big EMR vendors got involved with the integration project, smaller tech vendors weren’t fond of many of their APIs .

More than a quarter of those using Epic and Cerner APIs rated them poorly, followed by 30% for NextGen, GE and MEDITECH and a whopping 50% for eClinicalWorks. The smaller vendors’ favorite APIs seemed to be the ones offered by athenahealth, Allscripts and McKesson. According to Holt, athenahealth’s API got the best ratings overall.

All that being said, some of the smaller vendors weren’t that enthusiastic about pushing for integration with big EMR vendors at present. Of the roughly 30% who haven’t integrated with such vendors, half said it wasn’t worth the effort to try and integrate, for reasons that included the technical or financial cost would be too great. Also, some of the vendors surveyed by Health 2.0 reported they were more focused on other data-gathering efforts, such as accessing wearables data.

Still, EMR vendors large and small need to change their attitude about opening up the platform, and smaller vendors need to support them when they do so. Otherwise, the industry will remain trapped by a self-fulfilling prophecy that true integration can never happen.

Enterprise EHR Vendors Consolidating Hold On Doctors

Posted on September 9, 2016 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.