Welcome to EMR and EHR

I got the following 6 EHR myths from this presentation:
Myth #1: EHR Projects are IT Projects
Myth #2: EHR Software is useful out of the box
Myth #3: EHR Vendors will provide all the project management and assistance I need
Myth #4: I can manage my own EHR project
Myth #5: All EHRs are the same
Myth #6: EHRs can communicate with one another

I thought this was an interesting list to consider. The only one that kind of bothers me is Myth #4. I think this one really depends on the size of the practice and the skill of the physician/office manager. Many a clinic had done a great job implementing an EMR on their own. Granted, there are probably more failed ones who’ve gone it on their own. I guess I’ll stand that you can do it on your own, but be sure to know what you don’t know. Don’t be afraid to ask for help with those things you don’t know.

What do you think of this list?

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.

It just absolutely amazes me how many companies are coming out with brand new EMR software and trying to compete with all the various EMR vendors out there. Obviously, that’s a very good thing for me, but it seems like every day a new EMR vendor whom I’ve never heard of is launching a new EMR software.

What’s amazing is that each company is taking their own little angle on the market. It kind of goes back to my assertion that there isn’t 1 EMR market, but 50 EMR markets. Plus, with only 15% adoption (or choose your favorite adoption number) we’re just at the beginning of the competition.

Just to illustrate my point, here’s a press release I just got in my email talking about a worksite health center EMR (see below). It’s really interesting the creative ways that EHR vendors are trying to market their software. Plus, there’s a whole group of EMR vendors who have create a software and don’t have any clue how to market their product.

Fort Wayne, Ind. – May 11, 2010 – Concentra, a leading provider of employer health care services, announced today that it will utilize Medical Informatics Engineering (MIE) to bring electronic health records (EHR) and employee health portal services to Concentra clients through its worksite health centers. As more companies seek ways to control rising health care costs and improve the health and wellness of their employees, workplace health care centers with advanced health information systems are becoming an increasingly popular choice.

Concentra has expanded its workplace service offerings to include primary care services, wellness programs and personal coaching, and MIE’s WebChart Enterprise Health EHR system, providing a comprehensive health care solution directly to employees. To date, the advanced information technology system has been implemented at five Concentra worksite locations, with more slated for implementation throughout 2010. WebChart offers a flexible suite of health information products that Concentra uses to support its innovative service delivery model, allowing for each implementation to accommodate the specific needs of each client.

“MIE stood out from other EHR vendors due to their extensive experience in and first-hand knowledge of the occupational and primary health care IT space,” said Concentra Senior Vice President of Medical Operations Bill Lewis, M.D. “MIE’s Web-based, Software as a Service (SaaS) EHR model allows for integration with other employer and employee health systems, and is easily customized to meet the needs of our clients, in a wide range of industries and backgrounds.”

Through MIE’s WebChart Enterprise EHR, Concentra clients can give their employees access to send health information to the worksite health center prior to a visit. Employees can also schedule visits online, review lab results online, answer health-related questionnaires, and report work-related injuries and illnesses. Medical information documented in the EHR during a clinical encounter can then be synced to the employee’s portal page, or shared with a personal health record (PHR) solution like Google Health, Microsoft HealthVault, or NoMoreClipboard.com.

“MIE’s versatile EHR module provides a user-friendly interface for a diverse group of employer stakeholders, including employees, supervisors, and health care providers, leading to improved productivity and communication between all parties,” added Lewis.

“Medical Informatics Engineering is honored to work with an organization like Concentra that is dedicated to improving the health of America’s employees and reducing the cost of health care for employers,” said Peter Norder, Executive Vice President of MIE. “Concentra’s impressive focus on streamlining the delivery of health care and measuring the benefits of improved patient care, through more than 250 workplace health clinics in the U.S., lines up exceptionally well with MIE’s mission to put employers and employees at the center of their own health care.”

By implementing advanced information systems, caring for employees, and delivering outcomes-based clinical practices, Concentra has become the leading provider of worksite employee health services for employers in dozens of different industries. With more than 250 worksite medical clinics and 300 national medical centers, Concentra serves more than 100,000 employers across the nation and treats more than 25,000 patients each day.

For more information, please visit www.concentra.com and/or www.mieweb.com.

I meant to post this a long time ago and never got around to it. Although, I think it was one of the really interesting announcements at HIMSS. Here’s a portion of the press release from Quest about their EHR offering:

“Quest Diagnostics is making broadly available a Web-based EHR that helps physicians embrace digital healthcare one step at a time, connect easily with their peers on patient care, and achieve meaningful use that allows them to qualify for government incentives,” said Richard A. Mahoney, Quest Diagnostics’ vice president of Healthcare Information Solutions and president of its MedPlus healthcare information technology subsidiary. “We value the longstanding trust physicians have in our company, and we are proud to answer physicians’ needs with a modular technology that will truly help drive meaningful improvements in quality of care.” MedPlus develops the technologies that power the Care360 suite of physician offerings.

Each week I’m introduced to another interesting type of organization that’s trying to use their connections and relationships with doctors to sale an EHR. Who’s connections are going to win?

Of course, one question that will be interesting for Quest is how they’ll handle interfaces between their Care360 EHR and other vendors. I assume you’ll have to have a Quest lab interface as part of the deal. Does that mean all other labs are shut out? I can imagine that many doctors will be reticent to go with a Quest EHR if it basically locks them into a relationship with only Quest. It’s going to be interesting to see how this plays out.

One of my readers sent me the following email…

New England Journal of Medicine survey:
46% of primary care physicians would quit if Obamacare becomes law!

I’m not sure I agree with the statement. Should I? If this does happen, how will it affect the EMR industry? Should EMR vendors should be preparing for the healthcare reform (Obamacare) in their projections?

HISTalk had this insightful point:

From Day Tripper: “Re: ambulatory EMR vendors. I asked several EMR vendors if they have seen a big increase in buyers, especially now that we at least have the interim final use definitions. The general consensus is that many physicians are still dragging their feet.” I’ve heard that comment as well. Either because of fear or because it sounds like a good excuse, many physicians are waiting until the MU guidelines are truly final and the certifying entities are identified. Perhaps a minority of physicians are savvy to understand that the RECs will offer some free implementation services so they are waiting for those to ramp up. And, likely others are waiting to see what opportunities their hospitals may offer to affiliated physicians. In other words, if you are looking for an excuse to not move forward, there are plenty to choose from.

I ask a number of EMR vendors the same question. A few had seen some increase, but for the most part they were all still waiting. I think Inga’s comment that there being plenty of excuses to not implement is true. This is unfortunate, since before the EMR stimulus most of the excuses had played themselves out and nearly disappeared. It seems that the EMR stimulus offered up a new set.

I will say that I’m not so sure how much “free” help the RECs will end up giving. I really wonder what most of them are going to do. One of my projects since HIMSS is to make contact with a number of the RECs.

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.”

As if this was a major announcement, but EMR is leading the growth in the healthcare IT market according to a report by Scientia Advisors:

A new report from Scientia Advisors says health IT is the fastest-growing segment of what the Cambridge, Mass., management advisory company calls a $1 trillion global healthcare products marketplace. Health IT currently is growing at an 11 percent annual rate, and solid growth should continue at least through 2013, which would be the third year of the federal EMR stimulus program here in the States, the Scientia report forecasts. In that time frame, health IT will increase its market share by a quarter, to 5 percent of global healthcare products sales from the current 4 percent.

They also predicted that established EMR vendors should benefit the most from increased spending. “Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia says.

There’s no doubt they’re going to gain major market share. Add in major mergers and acquisitions by the major players and these companies are going to become huge. Can you imagine the support doctors are going to get from these major EMR vendors?

I was really intrigued by this letter sent from SRSsoft CEO, Evan Steele, to the CTO of the Obama Administration about the current administration’s EHR direction. Here’s a small excerpt from the letter posted on Health Data Management:

“I am writing to you directly, rather than posting on the FACA blog, because I am deeply concerned that the path the government is taking will inevitably lead to failure. You asked physicians for input and they answered loudly and clearly–traditional EHR technology does not work for them. Their comments are difficult to ignore.

“The government is endorsing the exact technology that has a 50% failure rate. As stated in the blog comments, physicians simply find these EHRs unusable. Of the 60 blog comments on real-world implementation experiences, 57 reported EHR failures and shortcomings–writers documented painful and costly EHR de-installations, or explained the reasons why they would not even try to implement “traditional” EHRs. There is no reason to expect outcomes to be different in the future–vendors have made no significant changes to these products to mitigate the formidable obstacles preventing their adoption. The problems cited are daunting:

* “Physicians will not purchase productivity-decreasing software–particularly now, as they face increasing demand and diminishing reimbursements. They reported productivity losses as high as 40%, and the impact did not diminish over time.

The sad part is that Evan’s letter is likely to fall on deaf ears. First, because Aneesh Chopra probably doesn’t care much about EMR software. Second, a letter from an EMR vendor who wants the rules changed to get better access to the $36.3 billion in EMR stimulus money for his customers is likely to be seen as a political move. Even if Evan is correct with what he’s saying, that doesn’t mean that Aneesh will realize it. Third, is it too late? The HITECH legislation is past. Can HHS really make that much of a difference at this point? Sadly, I don’t think Evan we’ll feel any better 2 years from now when he says, “I told you so.”