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Top 10 Blog Posts on EMR and EHR from 2017

Posted on January 4, 2018 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.

As we kick off 2018, I thought it would be fun to look back at the top 10 blog posts (based on views) in 2017 for EMR and EHR. It’s always great to see what people found interesting and which topics were of interest to readers. Plus, I’m always fascinated to see what old articles are still of interest to people. Not to mention, to look at what has changed since the article was written.

Facebook in Healthcare – What’s amazing about this blog post is that it’s from 2014. Looking back 3+ years later, I haven’t really seen Facebook become a big player in healthcare. Sure, there are plenty of patient groups on Facebook, but it’s not really a Facebook product. Facebook has done a number of things in healthcare over the years to get the word out about organ donation and things like that, but I currently don’t see them as a big player in healthcare the same way Amazon, Google, and Apple are looking at healthcare.

What the EMR Industry Can Learn From Facebook – Amazing that another article about Facebook was in the Top 10 and this one from 2012 was written by Priya Ramchandran. Her vision of a world where a patients health record was just automatically pushed down to a server every time we have a health encounter has been far from realized. The challenge of the comparison for me is that Facebook has a reason to push all that data together. In healthcare, there are reasons why organizations don’t want to push the data out to the patient. Until we change those reasons, we won’t see this vision despite hundreds of companies efforts to try and accomplish it. Yes, even Apple is working on solving this problem now and I think they’ll fail.

Epic Launches FHIR-Based App Platform – Epic’s launch of the Epic App Orchard platform was big news in 2017. I’ll admit that I’m still a bit skeptical about Epic App Orchard. Many herald it as Epic opening up their EHR to developers. I personally am skeptical and fear that it’s really just making public the connections they were already creating and is more PR than anything. Epic App Orchard isn’t a truly open API that would allow innovators and entrepreneurs to build on top of the Epic EHR. Plus, I fear that Epic App Orchard is just a new revenue stream for Epic. Those are my fears that I’ll be exploring as I talk to people in 2018 about it.

Publicly Traded Health IT Companies – I wouldn’t have thought of this blog post as one that would have garnered a lot of attention. Maybe that means we should do more work covering the publicly traded healthcare IT companies on this blog. They seem to be increasingly dominating the landscape.

Artificial Intelligence in Healthcare: Medical Ethics and the Machine Revolution – One of the great additions to EMR and EHR this year was Janae Sharp and this blog post was an excellent example of her work. Understanding the impact of AI in healthcare is going to be an extremely important topic over the next decade. I’m glad she kicked off the conversation since it’s a challenging one. I still keep thinking about the question she asked, “Can a machine learn empathy?” Chew on that one for a while.

EHR Innovation & Regulation: Friends or Foes? – I’m really glad that this post by Stephen Dart from AdvancedMD did so well. I think most doctors don’t appreciate the challenging situation EHR vendors are in when it comes to balancing compliance and innovation. I believe it’s the core of what’s wrong with most EHR software out there and contributes to a lot of physician burnout.

Is Cerner Edging Up On Epic? – This post was from 2016, but the question is still a good one. The reality is that both Cerner and Epic are doing amazingly well. I don’t see anything on the horizon that’s going to change it. Both of them are behemoths that are doing incredibly well. I don’t really see either of them cutting into the progress of the other either. What do you think?

Is Your Health Data Unstructured? – Enabling an AI Powered Healthcare Future – I still love the insight shared in this article. Technology doesn’t solve your problems. Technology amplifies your current state. If you’re doing a good job, technology will accelerate the good. If you’re doing poorly on something, technology will accelerate and amplify the bad.

#HIMSS17 Mix Tape – This is just a fun post leading into HIMSS that Colin has done every year with us for a lot of years. The exciting part is that when Colin posted this he was still working at a Healthcare IT vendor. We’re lucky to now have him formally as part of the Healthcare Scene team. I’m quite sure Colin will be doing a #HIMSS18 Mix Tape shortly. So, if you have suggestions, reach out to him on Twitter.

12 Reasons Why EMRs Improve Patient Care – How amazing that this post from 2011 is still doing so well. I imagine it’s because so many people are trying to understand the value of the EHR. Especially as it related to improving patient care. This post really deserves a future dedicated blog post to look at the 12 ways EMR improve patient care and how many of them have been realized. I’ll put it on my to-do list for 2018.

There you have it. The top 10 blog posts on EMR and EHR for 2017. It’s always fun to look back and see what’s changed and what’s stayed the same. Thanks to each of you for reading and supporting the work we do here. Now on to an awesome 2018!

Are Improved EMR UI Designs On The Way? I Doubt It

Posted on December 4, 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.

More or less since EMRs were first deployed, providers have been complaining about the poor quality of the interface they’ve had to use.  Quite reasonably, clinicians complained that these interfaces weren’t intuitive, required countless extra keystrokes and forced their work processes into new and uncomfortable patterns.

Despite many years of back and forth, EMR vendors don’t seem to be doing much better. But if a new story appearing in Modern Healthcare is to be believed, vendors are at least trying harder. (Better late than never, I suppose.)

For example, the story notes, designers at Allscripts create a storyboard to test new user interface designs on providers before they actually develop the coded UI. They use the storyboard to figure out where features should sit on a given screen.

According to the magazine, designers at several other EMR vendors have begun going through similar processes. “They are consulting with and observing users inside and outside of their natural work environments to build EHRs for efficient – and pleasant – workflows, layouts and functionality,” the magazine reports.

Reporter Rachel Arndt says that major EHR vendors now rely on a mix of approaches such as formal user testing and collection of informal feedback from end-users to meet their products more usable for clinicians. In some cases, this has evolved into official UI design partnerships between EHR vendors and customers, the story says.

Okay. I get it. We’re supposed to believe that vendors have finally gotten their heads together and are working to make end-users of their products happier and more productive. But given the negative feedback I still get from clinicians, I find myself feeling rather skeptical that the EHR vendors have suddenly gotten religion where UI design is concerned.

For what it’s worth, I have no doubt that Ms. Arndt reported accurately what the vendors were telling her. If any of us would ask vendors they are partnering with customers – especially end-users – to make their products more intuitive to work with, they will swear on a stack of user manuals that they’re improving usability every day.

Until I hear otherwise, though, I’m not going to assume that conditions have changed much out there where EHR usability is concerned. Today, all the feedback I get suggests that EHRs are still being designed to meet the needs of senior management within provider organizations, not the doctors and nurses that have to use them every day.

Of course, I hope I’m wrong, and that the story is accurate in ways that offer some hope to clinicians. But for now, color me very doubtful that EMR vendors are making any earth-shattering UI improvements at present.

Will 2018 Be The Year Of The Health IT/Non-Health-IT Merger?

Posted on December 1, 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.

Within the last several days, the news broke that Amazon Web Services would probably be doing some sort of far-reaching cloud deal with Cerner. Given that AWS is a nearly $20 billion cloud organization, and Cerner one of the largest health IT players in the game, a lot could happen here.

My guess, not that it’s any leap of imaginative genius, is that if the currently-rumored deal between the two partners works, Amazon will make a serious bid to buy out Cerner as a whole. Given the massive profits potentially at stake in health IT, the idea of such an acquisition seems credible to me, at least if Cerner’s stockholders approve. After all, isn’t Amazon the company that just did a multibillion-dollar buyout of Whole Foods to fuel its growing (but still relatively small-scale) efforts in food retailing?

Not only is this particular deal interesting, I think it may portend some major structural changes in the health IT business as a whole. Specifically, I think we’re reaching a point where there will be a lot of pressure on companies with adequate cash and compatible goals to target HIT organizations, particularly if they need to scale up quickly and don’t have much internal knowledge on the subject.

And there’s no question that as healthcare settles into being a digital business, a range of digital businesses outside of healthcare will see that as an opportunity to step into such an important market. After all, how could they not want to be part of any organization that’s competing effectively in an industry that consumes a double-digit portion of the US GDP?

Over this period, many small internal workgroups outside healthcare will be transformed into scouting units seeking the next big digital healthcare deal. At the same time, these divisions will start forming quiet alliances strategic to their business, not only with giants like Cerner and Epic but also well-positioned startups in hot areas such as, say, blockchain security or supply chain management. (How could an ERP vendor not wonder how a healthcare supply chain management company running over blockchain could enhance their business?)

Then, of course, there are the more obvious moves which will bring a new critical mass of health IT customers, knowledge and talent to companies with a giant market presence already, such as Apple and Samsung.

Such M&A efforts won’t be optional. As Microsoft’s experience has proven in the past, and Amazon has apparently found more recently, you can’t just storm into the enterprise healthcare world and demand your cut, no matter how big a player you are. Getting there will take a well-finessed, mutually-fruitful agreement, if not an acquisition, even for a mega-company like Google/Alphabet.

Now, can I tell you which companies will be executing on such deals next year? I have a few theories, but no specific intelligence to share that you couldn’t pick up on your own by skimming industry headlines. But I do stand by my prediction that by the end of 2018, we’ll have seen a few spectacular deals between HIT vendors and digital companies outside the industry that will have a major influence for years to come.

AMA Promotes Common Model For Health Data Organization

Posted on October 24, 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.

What do we really need to make the best use of shared patient data?  Some say that once we have adequate data sharing protocols in place (such as FHIR or Direct), organizing and using the data will be well within our capabilities. Other efforts assume that if we pulled together the right common data set, deciding how to exchange the data physically won’t be as big of an issue as it has been.

A new initiative from the American Medical Association seems to fall into the latter category The AMA has announced that it’s created a common data model which it says is missing in healthcare. The Integrated Health Model Initiative (IHMI), which has attracted the support of heavy hitters like IBM and Cerner, is a “shared framework for organizing health data, emphasizing patient-centric information, and refining data elements to those most predictive of achieving better outcomes,” according to an AMA statement.

The AMA and its partners said that the new model will include clinically-validated data elements which it says can speed up the development of improved data organization, management and analytics. Its initial focus will be on costly chronic diseases such as hypertension, diabetes and asthma.

The effort will include technical development efforts which will address interoperability problems, cumbersome or inadequate data structures and poor interface designs which forced physicians to click far too often, the trade group said.

From my standpoint, there’s a lot that’s hazy about this announcement, which was long on form but pretty short on substance.

For one thing, it’s not clear what Cerner, in particular, is getting out of this effort. It’s already an anchor member of the CommonWell Health Alliance which, having merged with rival group Carequality, arguably offers as mature an interoperability model as any out there today. Also, while even a giant like IBM needs continued press attention, I’m not sure how much benefit it will realize here.

Not only that, it’s hard to tell where the AMA and partners will take IHMI. The trade group has posted a set of data model specifications to its site. The group has also created a process wherein physicians review data elements and missions and decide whether they meet clinical applicability and consistency requirements. In addition, it’s creating technical and clinical communities focused on key sub-areas of interest. But it’s still not clear what all of this means and why it’s important.

Ultimately, the initial press release is as much a buzzword cloud as it is a statement of intent. Pardon my cynicism, but I doubt even a group with the AMA’s clout can fix interoperability problems, streamline data structures and foster more elegant UI design in health IT in one fell swoop.

The announcement does do something useful regardless, however. While I’m not personally qualified to say whether it will take universally accepted standards for data exchange, a widely-used reference set for health data or both, I believe someone should address these questions. As proposed interoperability solutions pop up on both sides, perhaps we’ll get some answers.

 

Health System Sues Cerner Over Billing-Related Losses

Posted on October 5, 2017 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

Mental Health EMRs And MIPS – MACRA Monday

Posted on September 18, 2017 I Written By

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

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

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

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

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

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

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

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

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

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

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

USAA Tapping EHR To Gather Data From Life Insurance Applicants

Posted on August 10, 2017 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

Researcher Puts Epic In Third Place For EMR Market Share

Posted on May 16, 2017 I Written By

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

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

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

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

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

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

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

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

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

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

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

Epic Launches FHIR-Based App Platform

Posted on March 2, 2017 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rival Interoperability Groups Connect To Share Health Data

Posted on December 27, 2016 I Written By

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

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

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

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

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

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

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

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

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

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

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

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