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I Have Seen The Portal, And It Is Handy

Posted on July 14, 2015 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.

After writing about EMRs/EHRs and portals for many years, I’ve finally begun using an enterprise-class portal to guide my own care. Here’s some of my impressions as an “inside” (EMR researcher) and “outside” (not employed as a provider) user of this tool. My conclusion is that it’s pretty handy, though it’s still rather difficult to leverage what I’ve learned despite being relatively sophisticated.

First, some background. I get most of my care from northern Virginia-based Inova Health System, including inpatient, primary care, imaging and specialist care. Inova has invested in a honking Epic installation which links the majority of these sites together (though I’ve been informed that its imaging facilities still aren’t hooked up to core medical record. D’oh!) After my last visit with an Inova doctor, I decided to register and use its Epic portal.

Epic’s MyChart has a robust, seemingly quite secure process for registering and accessing information, requiring the use of a long alphanumeric code along with unique personal data to establish an account. When I had trouble reading the code and couldn’t register, telephone-based tech support solved the problem quickly.  (Getting nearsighted as I move from middle- to old-aged!)

Using MyChart, I found it easy to access lab results, my drug list and an overview of health issues. In a plus for both me and the health system, it also includes access to a more organized record of charges and balances due than I’ve been able to put together in many years.

When I looked into extracting and sharing the records, I found myself connected to Lucy, an Epic PHR module. In case you’ve never heard of it (I hadn’t) here’s Epic’s description:

Lucy is a PHR that is not connected to any facility’s electronic medical record system. It stays with patients wherever they receive care and allows them to organize their medical information in one place that is readily accessible. Patients can enter health data directly into Lucy, pull in MyChart data or upload standards-compliant Continuity of Care Documents from other facilities.

As great as the possibility of integrating outside records sounds, that’s where I ran into my first snag. When I attempted to hook up with the portal for DC-based Sibley Memorial Hospital — a Johns Hopkins facility — and integrate the records from its Epic system into the Inova’s Lucy PHR, I was unable to do so since I hadn’t connected within 48 hours of a recent discharge. When I tried to remedy the situation, an employee from the hospital’s Health Information Management department gave me an unhelpful kiss-off, telling me that there was no way to issue a second security code. I was told she had to speak to her office manager; I told her access to my medical record was not up for a vote, and irritated, terminated the call.

Another snag came when I tried to respond to information I’d found in my chart summary. When I noted that one of my tests fell outside the standard range provided by the lab, I called the medical group to ask why I’d been told all tests were normal. After a long wait, I was put on the line with a physician who knew nothing about my case and promptly brushed off my concerns. I appreciate that the group found somebody to talk to me, but if I wasn’t a persistent lady, I’d be reluctant to speak up in the future given this level of disinterest.

All told, using the portal is a big step up from my previous experiences interacting with my providers, and I know it will be empowering for someone like myself. That being said, it seems clear that even in this day and age, even a sophisticated integrated health system isn’t geared to respond to the questions patients may have about their data.

For one thing, even if the Lucy portal delivers as promised, it’s clear that integrating data from varied institutions isn’t a task for the faint of heart. HIM departments still seem to house many staffers who are trained to be clerks, not supporters of digital health. That will have to change.

Also, hospitals and medical practices must train employees to enthusiastically, cheerfully support patients who want to leverage their health record data. They may also want to create a central call center, staffed by clinicians, to engage with patients who are raising questions related to their health data. Otherwise, it seems unlikely that they’ll bother to use it.

Epic Tries To Open New Market By Offering Cloud Hosting

Posted on November 26, 2014 I Written By

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

When you think of Epic, you hardly imagine a company which is running out of customers to exploit. But according to Frost & Sullivan’s connected health analyst, Shruthi Parakkal, Epic has reached the point where its target market is almost completely saturated.

Sure, Epic may have only (!) 15% to 20% market share in both hospital and ambulatory enterprise EMR sector, it can’t go much further operating as-is.  After all, there’s only so many large hospital systems and academic medical centers out there that can afford its extremely pricey product.

That’s almost certainly why Epic has just announced  that it was launching a cloud-based offering, after refusing to go there for quite some time.  If it makes a cloud offering available, note analysts like Parakkal, Epic suddenly becomes an option for smaller hospitals with less than 200 beds. Also, offering cloud services may also net Epic a few large hospitals that want to create a hybrid cloud model with some of its application infrastructure on site and some in the cloud.

But unlike in its core market, where Epic has enjoyed incredible success, it’s not a lock that the EMR giant will lead the pack just for showing up. For one thing, it’s late to the party, with cloud competitors including Cerner, Allscripts, MEDITECH, CPSI, and many more already well established in the smaller hospital space. Moreover, these are well-funded competitors, not tiny startups it can brush away with a flyswatter.

Another issue is price. While Epic’s cloud offering may be far less expensive than its on-site option, my guess is that it will be more expensive than other comparable offerings. (Of course, one could get into an argument over what “comparable” really means, but that’s another story.)

And then there’s the problem of trust. I’d hate to have to depend completely on a powerful company that generally gets what it wants to have access to such a mission-critical application. Trust is always an issue when relying on a SaaS-based vendor, of course, but it’s a particularly significant issue here.

Why? Realistically, the smaller hospitals that are likely to consider an Epic cloud product are just dots on the map to a company Epic’s size. Such hospitals don’t have much practical leverage if things don’t go their way.

And while I’m not suggesting that Epic would deliberately target smaller hospitals for indifferent service, giant institutions are likely to be its bread and butter for quite some time. It’s inevitable that when push comes to shove, Epic will have to prioritize companies that have spent hundreds of millions of dollars on its on-site product. Any vendor would.

All that being said, smaller hospitals are likely to overlook some of these problems if they can get their hands on such a popular EMR.  Also, as rockstar CIO John Halamka, MD of Beth Israel Deaconess Medical Center notes, Epic seems to be able to provide a product that gets clinicians to buy in. That alone will be worth the price of admission for many.

Certainly, vendors like MEDITECH and Cerner aren’t going to cede this market gracefully. But even as a Johnny-come-lately, I expect Epic’s cloud product do well in 2015.

Ebola Lapse in Dallas Offers Few Lessons, Except About Our Over-reliance on Technology

Posted on October 8, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Of all the EHR problems encountered daily across the country, the only one to hit the major news outlets was a non-story about a missed Ebola diagnosis in Dallas, Texas. Before being retracted, the hospital’s claim of an Epic failure launched a slew of commentary in the health IT field. These swirled through my head last night as I tried to find a lesson in the incident.

The facts seem to be as follows. A 42-year-old man named Thomas Eric Duncan arrived from Liberia and checked in to the emergency room at Texas Health Presbyterian Hospital Dallas complaining of symptoms consistent with an Ebola diagnosis. He told the admitting nurse he had come from Liberia, and the nurse entered the data into the Epic EHR.

The purpose of recording the patient’s travel history, however, seemed to be simply to determine the need for immunizations, so the EHR kept it within a nurse’s section of the data (which the hospital called a “workflow”) and did not display it to the doctor. The doctor sent Duncan home, where he came into contact with about 100 people who were potentially infected. His symptoms worsened and he returned to the hospital two days later, where he was finally diagnosed correctly and admitted.

Late night musing #1: If Texas Health Presbyterian Hospital Dallas can’t diagnose a case of Ebola, why do they think they can treat one? The hospital has won numerous awards, including one for patient safety–I guess you’re safe once you’re admitted.

Meanwhile, the city of Dallas waited several extra days to clean up infected sheets and other belongings from the Duncan home. In Africa, such detritis are recognized as a major source of new Ebola infections.

Late night musing #2: Does this reflect the competence of public health officials in this country? Maybe we should turn the job over to the Secret Service.

It’s really a shame that the national press jumped on the hospital’s announcement that the EHR was the source of the problem. Commenters criticized the hospital right away, asking why the nurse didn’t simply tell the doctor, and why the doctor didn’t ask on his own.

Finally, the hospital backed off from blaming Epic, thus making the hospital look even stupider and more guilty than it already appeared. Nevertheless, EHRs at some hospitals may be designed to flag warning signals.

Clearly, there are many layers to this health care failure. I don’t blame the nurse, or even the doctor. ERs are always busy, and the nurse might never have known who would see the patient or even be in the ER when the doctor finally saw him.

But I do find a small lesson in the brief appearance of the EHR as a pivotal character in the story. The nurse thought he or she was doing their job just by entering the data into the EHR, and the doctor thought he was doing his job by reading it. The EHR had loomed as a magical solution to health care workflow–in the minds of hospital administrators, if not the ER staff.

Maybe if the nurse knew that the travel history was for the purpose of immunizations, he or she would not have relied on the EHR to use that information for diagnosis. Besides showing the need for training, some of my colleagues suggest that this problem calls for FDA regulation of EHR interfaces. They also suggest that systems use good user interface design to highlight important information (which would require a definition of what’s “important”) or at least allow searches for critical elements of the record.

Late night musing #3: Behind this also lies the mindlessness of much data collected by EHRs. I’m sure the nurse knew whether the unfortunate Mr. Duncan was a smoker and whether he suffered from depression, because regulations require these things to be recorded. Travel history became just another one of these automatic requirements to be tossed into the EHR and forgotten.

My story also concerns the musings of other health IT commentators, who suggested that EHRs be better integrated into “workflows”–as if every clinician follows a mechanical path of treatment and the EHR can figure out what it is.

Another thoughtful posting calls for integrating infectious diseaess into clinical decision support. But as my colleague Sandra Raup (R.D., J.D., M.P.H.) points out, CDS depends on a long history of clinical data collection. One can’t instantly add a new disease.

It might have been useful for some international health organization to realize, when the Ebola outbreak began to spread, that it would eventually break out of central Africa, and then to provide an app to hospitals around the world for checking symptoms and travel history. There is certainly a creative role for health IT to play.

I think the messiness of the Texas Health Presbyterian Hospital Dallas story shows why EHR failures, numerous as they are, don’t get reported in the press. There are just too many complicating factors. The EHR is partly configured by the clinic’s staff, who thereby become responsible for some of its decisions. The EHR failure usually comes when the staff is under stress, when they have communication problems, when the patient’s condition is rare. Ascribing blame becomes a tangled mess; one must start designing systems with multiple, redundant points to catch failures that can fall through the cracks.

So one level, this is just another sad story of humanity’s tendency to trust too much in its technology, a story that ranges from the flight of Icarus to the sail of the Titanic and the failure of the Fukushima Daiichi nuclear power plant. On other, it’s a familiar story of a systemic problem leading to what’s sometimes called a “normal failure.” Not much new to learn, but lots of work to do. Clinicians have to evaluate EHRs and know how the data is used, a more open system in all directions.

Rep. Phil Gingrey Comes After Healthcare Interoperability and Epic in House Subcommittee

Posted on July 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On July 17th, the House Energy and Commerce Committee’s subcommittee on Communications and Technology and Health (that’s a mouthful) held a hearing which you can see summarized here. Brought into question were the billions of dollars that have been spent on EHR without requiring that the EHR systems be interoperable.

In the meeting Rep. Phil Gingrey offered this comment, “It may be time for this committee to take a closer look at the practices of vendor companies in this space given the possibility that fraud may be perpetrated against the American taxpayer.”

At least Rep. Gingrey is a former physician, but I think he went way too far when he used the word fraud. I don’t think the fact that many EHR vendors don’t want to share their healthcare data is fraud. I imagine Rep. Gingrey would agree if he dug into the situation as well. However, it is worth discussing if the government should be spending billions of dollars on EHR software that can’t or in more cases won’t share data. Epic was called out specifically since their users have been paid such a huge portion of the EHR incentive money and Epic is notorious for not wanting to share data with other EHR even if Judy likes to claim otherwise.

The other discussion I’ve seen coming out related to this is the idea of de-certifying EHR vendors who don’t share data. I’m not sure the legality of this since the EHR certification went through the rule making process. Although, I imagine Congress could pass something to change what’s required with EHR certification. I’ve suggested that making interoperability the focus of EHR certification and the EHR incentive money is exactly what should be done. Although, I don’t have faith that the government could make the EHR Certification meaningful and so I’d rather see it gone. Just attach the money to what you want done.

I have wondered if a third party might be the right way to get vendors on board with EHR data sharing. I’d avoid the term certification, but some sort of tool that reports and promotes those EHR vendors who share data would be really valuable. It’s a tricky tight rope to walk though with a challenging business model until you build your credibility.

Tom Giannulli, CMIO at Kareo, offers an additional insight, “The problem of data isolationism is that it’s practiced by both the vendor and the enterprise. Both need to have clear incentives and disincentives to promote sharing.” It’s a great point. The EHR vendors aren’t the only problem when it comes to not sharing health data. The healthcare organizations themselves have been part of the problem as well. Although, I see that starting to change. If they don’t change, it seems the government’s ready to step in and make them change.

A Look at the Nashville EHR Market

Posted on July 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I always love the discussions of the top healthcare markets in the US. When I hear this discussion, two cities that don’t likely get enough love and have a lot of healthcare companies are Nashville and Atlanta. Other people love to talk about Boston and San Diego is strong on the biotech side and has a growing mobile health side as well. Those are definitely some of the top cities for healthcare companies.

With this in mind, I was intrigued when Keith Cawley from Technology Advice emailed me some findings from a survey they did of the Nashville EHR market.

Here are the most interesting findings:

  • Epic, the number one national electronic health record vendor, does not rank among the top five vendors in Nashville
  • Nashville healthcare providers are significantly more satisfied with their EHR programs than providers nationwide
  • 16 percent of providers in Nashville have already switched EHRs
  • Adoption rate among certain specialties is significantly higher than national averages
  • Cost appears to be the number one consideration for Nashville EHR buyers

This feels a bit like a slam on Epic, but I don’t think that Keith has a dog in that fight. I think the findings that Epic does well nationwide, but hasn’t done well in Nashville is quite interesting and worthy of further exploration.

They also put out the Nashville EHR market infographic below. Most interesting to me is the percentages and how the EHR market is still very diverse. Of course, the market can be broken down into smaller segments where we see more domination by certain vendors, but we’re still seeing a lot of EHR diversity in every region.

Nashville EHR Market Infographic.

Is Epic the “Microsoft” of Healthcare?

Posted on July 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Iltifat Husain, MD from iMedicalApps has penned an interesting article about Apple’s partnership with Epic being a game changer for patients. For those keeping track at home, I’ve predicted something very different with the Apple – Epic partnership. I’m quite skeptical that anything will come from it. Although, I was even more struck by Iltifat’s description of Epic:

If your hospital is currently changing its EMR, more than likely, it’s going to Epic. Epic has essentially become the Microsoft for EMRs.

While there’s no arguing that Epic has done very well and has a large portion of the EHR market, I think it’s far from fair to say that Epic is the de facto choice for hospitals. In fact, many hospitals don’t even get that choice because of Epic’s business practices.

One thing I keep learning more and more is that healthcare is very regional. Maybe where Dr. Husain practices medicine Epic is the Microsoft of that community. However, there are other communities where this just isn’t the case. In fact, I have a story waiting in the hopper for my site Hospital EMR and EHR that talks about the Nashville EHR community. I think we have to be really careful generalizing our regional biases.

We’ll see how this plays out over time, but I don’t think Epic has quite reached Microsoft like dominance in the EHR industry. What do you think? Should I be giving Epic more credit than I’m giving them? Also, let me be clear. Epic has done amazing. Although, Microsoft created a relative monopoly in multiple product lines.

Epic Joins IBM To Pitch DoD Contract

Posted on June 19, 2014 I Written By

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

Hoping to be the lucky vendors that win a massive pending DoD deal, Epic Systems has team up with global technology giant IBM to compete for the DoD’s Healthcare’s Management Systems Modernization contract.

The new project comes after years of  struggles and changes of direction by the DoD, which has worked for years to integrate its system with the VA’s EMR. Back in 2009, the two giant federal agencies kicked off an effort to create an integrated medical record, the iEHR, which would offer every service member the ability to maintain a single EMR throughout their career and lifetime. But those efforts failed miserably, and the iEHR project was halted in February 2013.

Since then, the DoD has announced that it’s moving along with its iEHR plans once again, a sprawling project which the Interagency Program Office estimates the cost somewhere between $8 billion and $12 billion.

Meanwhile, the DoD Healthcare Management Systems Modernization is moving ahead, slated to replace the current Military Health System. The DHMSM should serve some 9.7 million beneficiaries.

The two partners certainly bring a strong bench to the table. Epic offers an interoperable platform which is one of the most adopted EMR systems in the country, and according to company officials,its open architecture supports more than 20 billion data transactions between systems every year.  Epic says that its customer community, which currently includes 100 million patients, exchanges more than 2.2 million records each month with of the EMR vendors, HISPs, HIEs, the VA, DoD and Social Security Administration.

IBM, meanwhile,is contributing its system integration, change management and expertise , ad experiments in delivering large-scale solutions in partnership with complementary software and services providers. IBM’s Federal Healthcare practice will lead the effort, backed by IBM global information technology,research and health care organizations which already collaborate with Epic in support of EMR solutions internationally.

Without a doubt, IBM is the grandfather of all big iron providers, so they don’t have a lot to prove.  And Epic is a clear leader in the enterprise EMR space, by some measures leading the pack by a considerable margin. It’s likely they’re a top contender for the job.

If the DoD does indeed choose the partnership of Epic and IBM to make its health IT transition, it seems likely that they’ll have recruited more than enough firepower to get the job done — though there’s always the question of whether Epic, which is used to bossing hospitals around, will function as well when the big bureaucracy of the DoD is calling the shots.

But what’s more worrisome is whether the DoD will work effectively with these two private sector companies, assuming t hey win the bid. As noted, the DoD’s track record with change management is nothing to write home about, to say the least, and bureaucratic waffling could conceivably undermine even the most expert efforts to bring DoD’s healthcare architecture into the future. As big and powerful as they are, IBM and Epic may be in for one heckuva ride. In fact, John’s even suggested that the best thing for Epic might be for them to not win the DoD EHR contract.

This Image Says it All – Paperless EHR Training

Posted on May 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love irony and so I loved this picture and message posted to Instagram by @Liz_Money. She said:

“The irony of teaching a paperless EMR. I have a massive binder of paper. And this is just the first draft of curricula that will have endless edits and reprints. #paperguilt”

Paperless EHR Training

For those keeping track at home, I think this is Epic, but it could be Cerner since she does some work on both.

All I can say is…we can do better!

Epic Go Live Impossible Without #Web25

Posted on March 13, 2014 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 Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

The World Wide Web turned 25 this week, which gives us all cause to stop and reflect on its role in healthcare IT. It goes without saying that systems like electronic medical records would have a hard time really taking off without the Internet. Yes, they probably could exist without it, but if you think providers have workflow issues now …

I found out about the Web’s birthday on the very day I called my daughters’ pediatrician to schedule their annual well visits. The receptionist (who didn’t sound stressed at all) kindly informed me that they will be scheduling all future appointments into the new electronic medical record (Epic). Since that isn’t scheduled to go live until April 1, she took my appointment date and time down, and told me another staff member would call me back to let me know my appointments had been made in the new system.

It sounded like they are trying their hardest to avoid duplicate data entry into the old and new systems, but are having to rely on paper and pen to make sure everything ends up where it’s supposed to be come go live. Oh, the irony. I’ve got April 1 (April Fool’s Day, no less) circled on my calendar. I think I’ll give them a call back then to see if anyone sounds remotely stressed, or if things seem to be going smoothly.

This particular healthcare system probably won’t be in the “EMR Buying Frenzy” you may have read about recently. The numbers are downright shocking to me. HealthcareITNews.com reports, “[O]ne-third to half of all large hospitals are looking to trade out their old EMRs by 2016.” That is a ridiculous amount of money set to be spent by facilities that likely made similar investments in the not-too-distant past.

As a patient, I have to wonder how those second-round EMR purchases will affect the cost and quality of care. Will the price of procedures go up to help hospitals pay for these new systems? The money has got to come from somewhere. Just how frustrated will my physician be with new workflows, especially if they’ve JUST gotten used to the previous EMR? If any provider wants to chime in, please do in the comments below.

In another wonderful twist of irony, it is the World Wide Web that now allows me and other cost-conscious patients to research healthcare costs at our local facilities, not to mention come together online to commiserate about similar experiences. It will be interesting to see where the Web and healthcare IT are in another 25 years. Surely we’ll have achieved true interoperability by then!

MinuteClinic Goes With Epic – What’s It Mean?

Posted on March 12, 2014 I Written By

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

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

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

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

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

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

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

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