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Epic Go Live Impossible Without #Web25

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!

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.

MinuteClinic Goes With Epic – What’s It Mean?

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.

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 @annezieger on Twitter.

Cleveland Clinic, Dell Offer Joint Epic EHR Service

Even when you’re a juggernaut the size of Epic, eventually you’re going to reach the point where your customer base is saturated and you need unique new directions to go. This new deal between Dell and the Cleveland Clinic may do just that for Epic.

This week at HIMSS, the two are announcing an agreement in which the two will offer consulting, installation, configuration and hosting services for Cleveland Clinic’s version of Epic. Under the deal struck between the two parties, customers can choose between a hosted version of the Epic instance and a full install on their site.

Cleveland Clinic execs say that their knowledge of using Epic, which they have for more than three years, will give them special expertise in helping providers adjust to Epic.  The Clinic has been selling Epic to providers  through its MyPractice Healthcare Solutions business.  To date, MyPractice has sold EMRs to more than 400 providers, including physicians, nurse practitioners and midwives within a 50 mile radius of Cleveland.

Working with Dell, the two companies plan to offer the new EMR service nationwide. The Cleveland Clinic will handle the EMR installation for new customers, and Dell provides the technology infrastructure. Epic gets a licensing fee for each of these deals, the customers’ relationship will be with Dell and the Cleveland Clinic.

As Dr. C. Martin Harris, CIO of the Cleveland Clinic, told Modern Healthcare, most medical practices and hospitals have EMRs in place, leaving only a much smaller group of first-time EMR buyers. But, Harris said, that minis still a big number. (And there’s always the practices still looking to switch.)

Turning Dell and the Cleveland Clinic into a sales channel for Epic seems like a pretty smart move. With the help of players who know the smaller physician practice market, it might open up a new opportunity for Epic which it hadn’t much of a shot at before.

February 27, 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 @annezieger on Twitter.

#HIMSS14 Highlights: the Snail’s Pace of Interoperability

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

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Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

February 26, 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.

KLAS Gives athenahealth, Not Epic, its 2013 “Best in KLAS” award

While Epic Systems may still be that the giant in the room, according KLAS, athenahealth is the best overall software vendor for 2013.

athenahealth’s taking first place pushes Epic to second for the first time in eight years. athenahealth got the most positive opinions from the thousands of providers participating in the KLAS poll, notably praise for the usability of its athenaClinicals, athenaCollector and athenaCommunicator products, according to EHR Intelligence.

athenahealth CEO Jonathan Bush was all too happy to take a victory lap. “The old guard of each IT leaders is finally being displaced by more nimble innovative models designed for healthcare’s future – not for its past,” Bush told EHR Intelligence.

Epic still remains in first place as for its overall software suite, reports EHR Intelligence. And it took home multiple prizes this year. But there’s a revolution brewing outside the Epic palace, it would appear. Not one that calls for angry peasants and pitchforks, but clearly some level of entrenched discontent is at work here.

Other well-known vendors of EMRs took their lumps as well. For example, Cerner came in at seventeenth, McKesson at 20th, and Allscripts came in 23rd.

So what to make of all of this? As my colleague John Lynn notes, awards of this kind are best taken with a grain of salt. After all, providers don’t need software that wins popularity contests, they need software which they can afford, which can handily meet Meaningful Use standards and which doctors and nurses and other clinicians can use without a hitch. Being sure their vendors win sexy awards really isn’t on their worry list.

Still, the fact that Epic has been unseated after eight years at the top of KLAS’s best vendor list may mean something. Perhaps Epic’s grip on the market is loosening a bit?

February 6, 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 @annezieger on Twitter.

Major EHR System Downtime Causing Issues

For many years, I’ve been writing about the potential damage that EHR down time can have on an organization. I’ve also been writing a number of things to try and help organizations battle against EHR downtime. For example, here’s a few of the articles I’ve written: Cost of EHR Down Time, Reasons Your EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. The reality is that EHR down time is going to happen and as more organizations adopt EHR it’s going to happen more frequently.

The past week I’ve gotten a number of people emailing me about the pain it’s been having their EHR down. Here’s one message I got from a doctor:

Today, the whole system ground to a halt and froze screens for 10 to 15 seconds at a time, which made it impossible to get our documentation done on time when trying to see 15 to 20 patients each in a day. Both myself and my colleague weren’t able to finish any of our work. My colleague called the system “unbearable” today. Hence, we get to spend the weekend working to catch up.

I guess it could be worse. We could be paying for it.

Another doctor on the same system wrote:

I have had nothing but trouble with my EHR the last two days. I can’t enter new notes. Their Help Desk takes 10 minutes to get respond on line. Not happy at all.

The former doctor had a similar complaint about the EHR helpdesk, but described the help desk’s response as “denying any problems exist even though it’s obvious when the problems do exist.”

Sometimes it’s not even the EHR vendor’s fault that the EHR is down, but it still illustrates the pain of not being able to access your EHR. HIStalk broke the news of the Epic EHR downtime (caused by a network issue) that occurred at Martin Health System in Florida. Here’s the CIO’s response to HIStalk’s inquiry:

Martin Health System had a hardware failure that has resulted in our network being down. The failure occurred the evening of Jan. 22 and we are continuing to work on rectifying the situation. Epic is among the systems being impacted by this hardware failure, however, it was not the genesis of the problem. We are continuing operations as scheduled, while strictly monitoring any potential patient safety concerns or issues that would require appropriate care determinations to be made. Our patient care teams are following downtime procedures and protocols to ensure patient safety and proper documentation is provided.

HIStalk offered more insight on the downtime a few days later:

From Scooper: “Re: Martin Hospital. You scooped the main media on their EHR crash.” I just happened to have a reader with a friend who was admitted at the time and he passed the information along to me. CIO Ed Collins was nice to provide a response. The contact said it was chaos in the hospital, with confused employees assigning random numbers to patients, runners delivering paper copies of everything, medication errors occurring, and unhappy family members threatening to sue everything that moved (all unverified, of course.) The hospital says the problem was hardware, not Epic, and claims (as hospitals always do) that patient care wasn’t impacted. Of course patient care was impacted – the $80 million system that runs everything went down hard. It would be interesting for Joint Commission or state regulators to show up during one of these hospital outages anywhere in the country to provide an impartial view of how well the downtime process works. All that aside, downtime happens and the key is preparing for it, just like Interstate Highway construction and lane-closing accidents. It’s not a reason to drive a horse and buggy.

It amazes me that it took them from Wednesday night until Friday morning to recover from the downtime. That seems like a failure of downtime procedures. I do find all of this EHR downtime really interesting in light of the recent video interview I did with Jason Mendenhall discussing healthcare in the cloud and data centers. They guarantee 100% uptime for power and connectivity. However, even in a 100% uptime data center, that doesn’t mean the application software might not have its own issues. Although, it does remove some points of failure.

HIStalk is right that EHR downtime happens. The key really is being prepared for when it does happen with proper downtime procedures. Although, that doesn’t mean healthcare and EHR vendors can’t do more than we’re doing now to make it happen less often.

My issue isn’t with EHR downtime, but with preventable EHR downtime. Plus, let’s own up to when it happens and learn from the experience. I know how hard it is on a call with EHR support to explain when a software is “down.” Sure, the server might be up and running, but end users know when something isn’t running smoothly in their EHR. Trying to convince low level EHR support people that it’s indeed an issue is a real challenge. It’s so much easier to point fingers than to try and fix the problem.

January 28, 2014 I Written By

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

KLAS Names Top EMR Vendors For Mid-Sized Practices

A new report by KLAS has designated Epic, athenahealth and Greenway as the top three EMR vendors among mid-sized healthcare practices.  The report, which also identified unpopular EMRs in the space, drew its conclusions based on analysis of ability, workflow and integration capabilities, according to iHealthBeat.

To do the study, KLAS interviewed clinicians and IT personnel at practices with 11 to 75 doctors.

Researchers named the top three mid-sized EMR vendors as Epic Systems, which scored a 85.3 points out of 100; athenahealth, which scored 83.5 points; and Greenway, which scored 81.3 points.

Each of the top three vendors distinguished themselves in unique ways.  For example, researchers found that practices liked Epic’s consistent delivery in large hospital-based practices, athenahealth’s “nimble deployment” and system updates, and Greenway’s exceptional service to smaller, independent practices.

Meanwhile, KLAS noted that Allscripts, McKesson and Vitera had the highest percentage of dissatisfied customers, practices which felt stuck with their current EMR system but would not purchase it again.  Reasons for their dissatisfaction included upgrade issues, lack of support, and a perceived lack of vendor partnership, iHealthBeat said.

When it comes down to it, it’s pretty clear when these practices need from their vendors, and a feeling of partnership and mutual support seems to top the list of matter which researchers is doing the study.  But it’s clear that these characteristics can be pretty hard to come by, even from companies you’d think had plenty of resources to deliver a sense of support and availability to their customers.  Allscripts, McKesson and Vitera (although it is Greenway now) had better get their act together quickly, as mid-sized medical practices are a major market, even if they don’t spend quite as much as hospitals.

January 27, 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 @annezieger on Twitter.

Epic EMR Training, Glucometer Workflow, New Media Meetup & MU Success


I think this is true for all EMR software, but particularly so for Epic. It’s always amazing how many skimp on EMR training and then pay the price for it later.


It’s a little hard to see, but illustrates the challenge associated with connecting these external data devices. It’s going to take a while for this to be commonplace and normal. I do find it interesting that they’re using Direct and the hardest interface to build (sending info to the EHR) is “Out of Pilot Scope.” I guess they don’t want to take on the hard stuff in the pilot.

These next 2 tweets are a little self serving since they point to posts on my EMR and HIPAA site. If you’re not subscribed to that site, you should go and do that now. Plus, one of these tweets is about a party at HIMSS, so I don’t imagine I’ll get any complaints there.


I hope to see many of you at HIMSS 2014!


I appreciate Dr. Webster recognizing this as a good one. While I’m biased, I think it’s a really important topic that needs more discussion. Although, I’m pretty sure it won’t be getting me an invite to any ONC dinner parties.

January 26, 2014 I Written By

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

Epic Hit With Class-Action Suit Over Worker Pay

A former employee has filed a class action suit against Epic Systems, arguing that the EMR vendor has been violating labor laws by denying some of its workers overtime pay.

The suit, which was filed by a former QA employee Evan Nordgren, contends that he and as many as 1,000 former and present QA workers should have been paid time-and-half for overtime hours. (Nordgren is now enrolled in the University of Wisconsin’s law school.) The suit concerns hours worked over a three-year period taking place prior to the filing of the lawsuit.

Epic, of course, disagrees with the suit’s assessment. It argues that state and federal law “make it clear that employees in computer-related jobs who primarily test software are appropriately classified as salaried professionals,” making them exempt from overtime pay.

Epic certainly has enough money to pay its employees whatever they’re due. The company had revenues of $1.5 billion in 2012, according to Forbes. Judy Faulkner, who founded Epic in 1979, has a net worth of about $2.3 billion and was ranked number 243 on Forbes 2013 list of the richest 400 Americans, according to the Wisconsin State Journal.

On other hand, if Epic is forced to cough up overtime pay to past and present QA employees, it seems likely — to me at least — that other suits of this type will follow, something no company wants to take on.  I guess we’ll have to wait and see on this one.

December 12, 2013 I Written By

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

One-Third of Chicago-Area Hospitals Come Together Into HIE

Thirty-four Chicago hospitals have decided to come together into a health information exchange, with plans to begin exchanging data early next year, according to a story in Modern Healthcare.

The group, which calls itself MetroChicago HIE, considers itself to have critical mass, given that it embraces about a third of the region’s 89 hospitals.

To exchange data, the HIE is using Direct protocols permitting basic, encrypted clinical messaging, such as the transmission of referral letters between providers which have established authentication and business relationships, Modern Healthcare notes.

Even with Direct protocols in hand to streamline data sharing, the hospitals will face significant challenges in tightening communications between their various EMRs, which include a number of Epic and Cerner installations, as well as a few Meditech shops. Planners will also face issues when they set out to link the HIE to office-based physicians.

To address the problem of communicating between multiple interfaces, the HIE has hired technology firm SandLot Solutions, a company launched by North Texas Specialty Physicians.

To date, many hospitals have been reluctant to sink big bucks into HIE development. But participating hospitals in Chicago seem confident that there is a business case for spending on an HIE.

The truth is, this may just be a tipping point for hospital-run HIEs generally. For example, a recent study by HIMSS Analytics and ASG Software Solutions concluded that almost 70 percent of the 157 senior hospital IT execs surveyed were involved in HIE efforts.

Now, let’s see how these Chicago hospitals handle data exchange when they move beyond Direct into more advanced sharing. That will really be where the rubber hits the road.

December 4, 2013 I Written By

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