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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.

A Circular Chat On Healthcare Interoperability

Posted on September 6, 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.

About a week ago, a press release on health data interoperability came into my inbox. I read it over and shook my head. Then I pinged a health tech buddy for some help. This guy has seen it all, and I felt pretty confident that he would know whether there was any real news there.

And this is how our chat went.

—-

“So you got another interoperability pitch from one of those groups. Is this the one that Cerner kicked off to spite Epic?” he asked me.

“No, this is the one that Epic and its buddies kicked off to spite Cerner,” I told him. “You know, health data exchange that can work for anyone that gets involved.”

“Do you mean a set of technical specs? Maybe that one that everyone seems to think is the next big hope for application-based data sharing? The one ONC seems to like.” he observed. “Or at least it did during the DeSalvo administration.”

“No, I mean the group working on a common technical approach to sharing health data securely,” I said. “You know, the one that lets doctors send data straight to another provider without digging into an EMR.”

“You mean that technology that supports underground currency trading? That one seems a little bit too raw to support health data trading,” he said.

“Maybe so. But I was talking about data-sharing standards adopted by an industry group trying to get everyone together under one roof,” I said. “It’s led by vendors but it claims to be serving the entire health IT world. Like a charity, though not very much.”

“Oh, I get it. You must be talking about the industry group that throws that humungous trade show each year.” he told me. “A friend wore through two pairs of wingtips on the trade show floor last year. And he hardly left his booth!”

“Actually, I was talking about a different industry group. You know, one that a few top vendors have created to promote their approach to interoperability.” I said. “Big footprint. Big hopes. Big claims about the future.”

“Oh yeah. You’re talking about that group Epic created to steal a move from Cerner.” he said.

“Um, sure. That must have been it,” I told him. “I’m sure that’s what I meant.”

—-

OK, I made most of this up. You’ve got me. But it is a pretty accurate representation of how most conversations go when I try to figure out who has a chance of actually making interoperability happen. (Of course, I added some snark for laughs, but not much, believe it or not.)

Does this exchange sound familiar to anyone else?

And if it does, is it any wonder we don’t have interoperability in healthcare?

New ONC Scorecard Tool Grades C-CDA Documents

Posted on August 2, 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.

The ONC has released a new scorecard tool which helps providers and developers find and resolve interoperability problems with C-CDA documents. According to HealthDataManagement, C-CDA docs that score well are coded with appropriate structure and semantics under HL7, and so have a better chance of being parseable by different systems.

The scorecard tool, which can be found here, actually offers two different types of scores for C-CDA documents, which must be uploaded to the site to be analyzed. One score diagnoses whether the document meets the requirements of the 2015 Edition Health IT Certification for Transitions of Care, granting a pass/fail grade. The other score, which is awarded as a letter grade ranging from A+ to D, is based on a set of enhanced interoperability rules developed by HL7.

The C-CDA scorecard takes advantage of the work done to develop SMART (Substitutable Medical Apps Resusable Technologies). SMART leverages FHIR, which is intended to make it simpler for app developers to access data and for EMR vendors to develop an API for this purpose. The scorecard, which leverages open-source technology, focuses on C-CDA 2.1 documents.

The SMART C-CDA scorecard was designed to promote best practices in C-CDA implementation by helping creators figure out how well and how often they follow best practices. The idea is also to highlight improvements that can be made right away (a welcome approach in a world where improvement can be elusive and even hard to define).

As SMART backers note, existing C-CDA validation tools like the Transport Testing Tool provided by NIST and Mode-Driven Health Tools, offer a comprehensive analysis of syntactic conformance to C-CDA specs, but don’t promote higher-level best practices. The new scorecard is intended to close this gap.

In case developers and providers have HIPAA concerns, the ONC makes a point of letting users know that the scorecard tool doesn’t retain submitted C-CDA files, and actually deletes them from the server after the files have been processed. That being said, ONC leaders still suggest that submitters not include any PHI or personally-identifiable information in the scorecards they have analyzed.

Checking up on C-CDA validity is becoming increasingly important, as this format is being used far more often than one might expect. For example, according to a story appearing last year in Modern Healthcare:

  • Epic customers shared 10.2 million C-CDA documents in March 2015, including 1.3 million outside the Epic ecosystem (non-Epic EMRs, HIEs and the health systems for the Defense and Veterans Affairs Departments)
  • Cerner customers sent 7.3 million C-CDA docs that month, more than half of which were consumed by non-Cerner systems.
  • Athenahealth customers sent about 117,000 C-CDA documents directly to other doctors during the first quarter of 2015.

Critics note that it’s still not clear how useful C-CDA information is to care, nor how often these documents are shared relative to the absolute number of patient visits. Still, even if the jury is still out on their benefits, it certainly makes sense to get C-CDA docs right if they’re going to be transmitted this often.

Dallas Children’s Health and Sickle Cell Patients: Cobbling Together a Sound Solution

Posted on June 23, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Sickle cell anemia (SCA) is a genetic, red blood cell condition, which damages cell walls impeding their passage through capillaries. Episodic, it is often extremely painful. It can damage organs, cause infections, strokes or joint problems. These episodes or SCA crises can be prompted by any number of environmental or personal factors.

In the US, African Americans are most commonly susceptible to SCA, but other groups can have it as well. SCA presents a variety of management problems in the best of circumstances. As is often the case, management is made even more difficult when the patient is a child. That’s what Children’s Health of Dallas, Texas, one of the nation’s oldest and largest pediatric treatment facilities faced two years ago. Children’s Health, sixty five percent of whose patients are on Medicaid, operates a large, intensive SCA management program as the anchor institution of the NIH funded Southwestern Comprehensive Sickle Cell Center.

Children’s Health problem wasn’t with its inpatient care or with its outpatient clinics. Rather, it was keeping a child’s parents and doctors up to date on developments. Along with the SCA clinical staff, Children’s Chief Information Officer, Pamela Arora, and Information Management and Exchange Director, Katherine Lusk, tackled the problem. They came up with a solution using all off the shelf technology.

Their solution? Provide each child’s caregiver with a free Verizon smartphone. Each night, they extracted the child’s information from EPIC and sent it to Microsoft’s free, vendor-neutral HealthVault PHR. This gave the child’s doctor and parents an easy ability to stay current with the child’s treatment. Notably, Children’s was able to put the solution together quickly with minimal staff and without extensive development.

That was two years ago. Since then, EPIC’s Lucy PHR has supplanted the project. However, Katherine Lusk who described the project to me is still proud of what they did. Even though the project has been replaced, it’s worth noting as an important example. It shows that not all HIE projects must be costly, time-consuming or resource intense to be successful.

Children’s SCA project points out the value of these system development factors:

  • Clear, understood goal
  • Precise understanding of users and their needs
  • Small focused team
  • Searching for off the shelf solutions
  • Staying focused and preventing scope creep

Each of these proved critical to Children’s success. Not every project lends itself to this approach, but Children’s experience is worth keeping in mind as a useful and repeatable model of meeting an immediate need with a simple, direct approach.

Note: I first heard of Children’s project at John’s Atlanta conference. ONC’s Peter Ashkenaz mentioned it as a notable project that had not gained media attention. I owe him a thanks for pointing me to Katherine Lusk.

Low-Profile HIT Player Leidos A Major Presence

Posted on June 1, 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.

Here where I live in the Washington, DC metro, federal IT is a major presence. Government IT consulting firms cluster along the area’s highways, and their executives own countless sprawling manses in the nearby suburbs. Those players include Leidos, a northern Virginia-based contracting firm with clients in IT, biomedical research and public health.

Though the firm has annual revenues of about $5.1 billion, and 18,000 employees, Leidos generates little fanfare here, despite a pedigree that includes a $5 billion partnership with Lockheed Martin’s Information Systems & Global Solutions segment that provides IT and intelligence services. However, Leidos is actually the new identity of long-established power player SAIC, which restructured and changed its name in late 2013 and has deep roots in national security and government IT contracting.

Most readers probably care little about government IT unless they service that industry. But I’d argue that we should all know about Leidos Health which, among other distinctions, was part of the team (Cerner, Leidos and Accenture Federal) that won the $4.3 billion plus contract to implement an EMR for the US Department of Defense last summer.

The DoD contract was hotly contested, by teams that included an Epic, IBM and Impact Advisors combination, but the Cerner-fronted team pulled off a win that may have saved the EMR vendor’s brand in a brutally competitive market. While it’s not clear what role Leidos played in the win, a DoD official was quoted as saying that a Cerner deal was projected to be “much cheaper,” and it’s possible Leidos support pricing played some role in its calculations. Perhaps more tellingly, DoD officials said cybersecurity considerations played a major role in the award, which plays to Leidos’ strengths.

Leidos Health hasn’t had unmitigated success. Most recently, it was part of a team scheduled to assist with a little-mentioned Epic EMR rollout for the US Coast Guard, which was cancelled due to “various irregularities.” The Coast Guard, which pulled the plug on the rollout in April, had been planning its EMR implementation since 2010.

However, this probably wasn’t much of a setback. And Leidos still delivers health IT services to several other federal agencies, including HHS and the Department of Veterans Affairs, including cybersecurity, health analytics, IT infrastructure and support and software development. And it works with the gamut of enterprise EMR vendors, including Allscripts, Cerner, Epic, McKesson and Meditech.

Truth be told, Leidos may not deserve the “quiet company” label given to it by Healthcare Informatics magazine, which recently dubbed it one the most interesting vendors of 2016. I’m sure Beltway execs who compete for federal contracts are well aware of Leidos Health, which had annual revenues of $593 million last year. And government IT decision-makers are well acquainted with parent company SAIC, a pillar of federal contracting which has been in the business since 1969. (In fact, SAIC president of technology and engineering Deborah Lee James was sworn in as Secretary of the Air Force in late 2013.)

That being said, the DoD deal has dramatically raised Leidos Health’s visibility in the broader health IT world. It will be interesting to see what it does going forward, don’t you think?