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Health Data Standardization Project Proposes “One Record Per Person” Model

Posted on October 13, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

When we sit around the ol’ HIT campfire and swap interoperability stories, many of us have little to do but gripe.

Is FHIR going to solve all of our interoperability problems? Definitely not right away, and who knows if it ever will? Can we get the big EMR vendors to share and share alike? They’ll try, but there’s always a catch. And so on. There’s always a major catch involved.

I don’t know if the following offers a better story than any of the others, but at least it’s new one, or at least new to me. Folks, I’m talking about the Standard Health Record, an approach to health data sharing doesn’t fall precisely any of the other buckets I’m aware of.

SHR is based at The MITRE Corporation, which also hosts virtual patient generator Synthea. Rather than paraphrase, let’s let the MITRE people behind SHR tell you what they’re trying to accomplish:

The Standard Health Record (SHR) provides a high quality, computable source of patient information by establishing a single target for health data standardization… Enabled through open source technology, the SHR is designed by, and for, its users to support communication across homes and healthcare systems.

Generalities aside, what is an SHR? According to the project website, the SHR specification will contain all information critical to patient identification, emergency care and primary care along with background on social determinants of health. In the future, the group expects the SHR to support genomics, microbiomics and precision medicine.

Before we dismiss this as another me-too project, it’s worth giving the collaborative’s rationale a look:

The fundamental problem is that today’s health IT systems contain semantically incompatible information. Because of the great variety of the data models of EMR/EHR systems, transferring information from one health IT system to another frequently results in the distortion or loss of information, blocking of critical details, or introduction of erroneous data. This is unacceptable in healthcare.

The approach of the Standard Health Record (SHR) is to standardize the health record and health data itself, rather than focusing on exchange standards.

As a less-technical person, I’m not qualified to say whether this can be done in a way that will be widely accepted, but the idea certainly seems intuitive.

In any event, no one is suggesting that the SHR will change the world overnight. The project seems to be at the beginning stages, with collaborators currently prototyping health record specifications leveraging existing medical record models. (The current SHR spec can be found here.)

Still, I’d love for this to work, because it is at least a fairly straightforward idea. Creating a single source of health data truth seems like it might work.

New Service Brings RCM Process To Blockchain

Posted on October 6, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Much of the discussion around blockchain (that I’ve seen, at least) focuses on blockchain’s potential as a platform for secure sharing of clinical data. For example, some HIT experts see blockchain as a near-ideal scalable platform for protecting the privacy of EHR-based patient data.

That being said, blockchain offers an even more logical platform for financial transactions, given its origins as the foundation for bitcoin transactions and its track record of supporting those transactions efficiently.

Apparently, that hasn’t been lost on the team at Change Healthcare. The Nashville-based health IT company is planning to launch what it says is the first blockchain solution for enterprise-scale use in healthcare. According to a release announcing the launch, the new technology platform should be online by the end of this year.

Change Healthcare already processes 12 billion transactions a year, worth more than $2 trillion in claims annually.  Not surprisingly, the new platform will extend its new blockchain platform to its existing payer and provider partners. Here’s an infographic explaining how Change expects processes will shift when it deploys blockchain:

Change_Healthcare_Intelligent_Healthcare_Network_Workflow_Infographic

To build out blockchain for use in RCM, Change is working with customers, as well as organizations like The Linux Foundation’s Hyperledger project.

Hyperledger encompasses a range of tools set to offer new, more-standardized approaches to deploying blockchain, including Hyperledger Cello, which will offer access to on-demand “as-a-service” blockchain technology and Hyperledger Composer, a tool for building blockchain business networks and boosting the development and deployment of smart contracts.

It’s hard to tell how much impact Change’s blockchain deployment will have. Certainly, there are countless ways in which RCM can be improved, given the extent to which dollars still leak out of the system. Also, given its existing RCM network, Change has as good a chance as anyone of building out blockchain-based RCM.

Still, I’m wondering whether the new service will prove to be a long-term product deployment or an experiment (though Change would doubtless argue for the former). Not only that, given its relatively immature status and the lack of broadly-accepted standards, is it really safe for providers to rely on blockchain for something as mission-critical as cash flow?

Of course, when it comes to new technologies, somebody has to be first, and I’m certainly not suggesting that Change doesn’t know what it’s doing. I’d just like more evidence that blockchain is ready for prime time.

FDA Announces Precertification Program For Digital Health Tools

Posted on October 5, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The FDA has recruited some the world’s top technology and medical companies to help it pilot test a program under which digital health software could be marketed without going through the through the agency’s entire certification process.

The participants, which include Apple, Fitbit, Johnson & Johnson, Samsung and Roche, will give the agency access to the measures they’re using to develop, test and maintain their software, and also how they collect post-market data.

Once armed with this information, the FDA will leverage it to determine the key metrics and performance indicators it uses to see if digital health software meets its quality standards.

Companies that meet these new standards could become pre-certified, a status which grants them a far easier path to certification than in the past. This represents a broad shift in the FDA’s regulatory philosophy, “looking first at the software developer digital health technology developer, not the product,” according to a report previously released by the agency.

If the pilot works as planned, the FDA is considering making some significant changes to the certification process. If their processes pass muster, pre-certified companies may be allowed to submit less information to the FDA than they currently must before marketing a new digital health tool.  The agency is also considering the more radical step of allowing pre-certified companies to avoid submitting a product for premarket review in some cases. (It’s worth noting that these rules would apply to lower-risk settings.)

The prospect of pre-certifying companies does raise some concerns. In truth, the argument could be made that digital health software should be regulated more tightly, not less. In particular, the mobile healthcare world is still something of a lawless frontier, with very few apps facing privacy, security or accuracy oversight.

The fact is, it’s little wonder that physicians aren’t comfortable using mobile health app data given how loosely it can be constructed at times, not to mention the reality that it might not even measure basic vital signs reliably.

It’s not that the healthcare industry isn’t aware of these issues. about a year ago, a group of healthcare organizations including HIMSS, the American Medical Association and the American Heart Association came together to develop a framework of principles dressing app quality. Still, that’s far short of establishing a certification body.

On the other hand, the FDA does have a point when it notes that a pre-certification program could make it easier for useful digital health tools to reach the marketplace. Assuming the program is constructed well, it seems to me that this is a good idea.

True, it’s pretty unusual to see the FDA loosen up its certification process – a fairly progressive move for a stodgy agency – while the industry fails to self-regulate, but it’s a welcome change of style. I guess digital health really is changing things up.

 

Why Should Patients Control Their Health Data? Here Are A Few Ideas.

Posted on September 29, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Lately, healthcare organizations have begun working to give patients more access to their personal health data. They’ve concluded that the more control patients have, the more engaged they become in your care, which in turn leads to better outcomes.

But patient engagement isn’t the only reason for giving patients the keys to their PHI. In fact, organizational control of patient health data can cause problems for everyone in the healthcare data exchange chain.

An item found on the Allscripts blog does a nice job of articulating issues that can arise.  According to the blog item, those issues include the following:

  • The patient is in the best position to address inconsistencies in their medical record. For example, if one doctor diagnoses the patient with asthma, then another physician conclusively demonstrates the patient is not asthmatic, the patient can reconcile the two physicians’ conclusions.
  • Patients have a better overview of their care than most doctors. When a chronically ill patient sees multiple clinicians, their impressions may conflict with one another, but the patient can provide context on their overall conditions.
  • If a patient consents to multiple uses of their health data, and the consents seem to be in conflict, only the patient can articulate what their intentions were.
  • If the master patient indexing process generates a false match with someone else’s records, the patient will recognize this immediately, while physicians may not.
  • Giving patients control of the record allows them to decide how long those records should be maintained. Otherwise, HIEs — or other entities not bound by record retention laws — might destroy the data prematurely.
  • When patients have control of their data, they can make sure it gets to whomever they choose. On the other hand, patient data may not make it to other care settings if providers drop the ball.

To be sure, delegating control of their PHI to patients can go too far.

For example, if they’re transmitting most or all of their health data between providers, it could pose a significant administrative burden.  Patients may not have the time or energy to route the data files between their providers, assure that data has been received on the other end and make certain that the data was formatted in a way their clinicians can use.

Also, if the patient is chronically ill and sees multiple providers, they may end up having to manage a large body of data files, and not everyone can do so effectively. Ultimately, they may get too overwhelmed to send their records to anyone, or send the wrong records, which can create complications of its own.

Still, on the whole, healthcare organizations are giving patients more control of their health data for good reasons. When patients take responsibility for their health data, they’re far more likely to understand their condition and take steps to address problems. Establishing a balance between patient and provider control may be tricky, but it can and should be done.

NY-Based HIE Captures One Million Patient Consents

Posted on September 28, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

One of the big obstacles to the free exchange of health data is obtaining patient consent to share that data. It’s all well and good if we can bring exchange partners onto a single data sharing format, but if patients don’t consent to that exchange things get ugly. It’s critical that healthcare organizations solve this problem, because without patient consent HIEs are dead in the water.

Given these issues, I was intrigued to read a press release from HEALTHeLINK, an HIE serving Western New York, which announced that it had obtained one million patient consents to share their PHI. HEALTHeLINK connects nearly 4,600 physicians, along with hospitals, health plans and other healthcare providers. It’s part of a larger HIE, the Statewide Health Information Network of New York.

How did HEALTHeLINK obtain the consents? Apparently, there was no magic involved. The HIE made consent forms available at hospitals and doctors’ offices throughout its network, as well as making the forms available for download at whyhealthelink.com. (It may also have helped that they can be downloaded in any of 12 languages.)

I downloaded the consent form myself, and I must say it’s not complicated.

Patients only need to fill out a single page, which gives them the option to a) permit participating providers to access all of their electronic health information via the HIE, b) allow full access to the data except for specific participants, c) permit health data sharing only with specific participants, d) only offer access to their records in an emergency situation, and e) forbid HIE participants to access their health data even in the case of an emergency situation.

About 95% of those who consented chose option a, which seems a bit remarkable to me. Given the current level of data breaches in news, I would’ve predicted that more patients would opt out to some degree.

Nonetheless, the vast majority of patients gave treating providers the ability to view their lab reports, medication history, diagnostic images and several additional categories of health information.

I wish I could tell you what HEALTHeLINK has done to inspire trust, but I don’t know completely. I suspect, however, that provider buy-in played a significant role here. While none of this is mentioned in the HIE’s press release or even on its website, I’m betting that the HIE team did a good job of firing up physicians. After all, if you’re going to pick someone patients would trust, physicians would be your best choice.

On the other hand, it’s also possible patients are beginning to get the importance of having all of the data available during care. While much of health IT is too abstruse for the layman (or woman), the idea that doctors need to know your medical history is clearly beginning to resonate with your average patient.

E-Patient Update: Sometimes Tech Gets In The Way

Posted on September 22, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Being such an enthusiastic tech user, I tend to assume that adding technology to the healthcare equation is a plus in almost any situation. Why not automate scheduling?  Data gathering? Pharmacy?

To me, it’s always seemed like a no-brainer that tech adoption works to my advantage as a patient. The more I can avoid going through basic motions manually, the better processes work, giving me more time to spend with my clinicians. Right?

Apparently, not so right. When you take patients into account, sometimes doing transactions the old-fashioned way may actually be more efficient – or at least more flexible – than running things through an automated process. If nothing else, it may be easier to accommodate patients if you don’t have to run them through your workflow.

That, at least, is the lesson I’ve gleaned from studying the day-to-day flow at Kaiser Permanente, where I get all of my healthcare. After watching Kaiser employees work, and asking a few unobtrusive questions, I’ve come to believe that going offline may actually be better in some situations.

Tech-friendly, but not tech-dependent

Now, make no mistake: Kaiser isn’t in the stone age technically. For example, it seems to build most of its clinical operations around what is reputed to be the mother of all Epic installations. (Back in the day, it was rumored that Kaiser spent roughly $4 billion to roll out Epic, a massive sum even by national organization standards.)

Throughout my care process, the fact that clinicians and support staffers are all on Epic has played to my advantage, particularly given that I have a few chronic illnesses and see several specialists. I’ve also benefited from other Kaiser technology, such as kiosks which automate my check-in process for medical visits.

In addition, I’ve gotten a lot of benefits from using Kaiser’s robust web portal, which offers the capability to exchange email messages with clinicians, set appointments, pay premiums and co-pays, order and track prescriptions and check test results.

All that being said, I’ve encountered manual processes at many steps in my journey through the Kaiser system. While some of these processes seem wasteful – such as filling out a standard pre-visit form on paper – others turn out to be more useful than I had expected.

‘People forget their card’

One situation where technology might not be needed is taking people into the doctors’ suite for consults. In theory, Kaiser could set up an airport- or DMV-style ticker letting people know when their doctor was ready to see them, but having nurses yell last names seems to work fine. I’d file this under “if it ain’t broke don’t fix it.”

The pharmacy is another area relying on a mix of low- and high-tech approaches. Interestingly, the pharmacy offers an airport-like board displaying the names of patients whose meds are ready. But when it comes to retrieving patient info and dispensing drugs, the front-line staffers enter the patient numbers by hand. I would have expected there to be a barcode on the membership card, but no dice.

According to one pharmacy tech, it has to be this way. “People forget their [Kaiser member] card all of the time,” she said. “We can’t assume members have It with them.”

These are just a couple of examples, but to me they’re telling. I may be missing something here, but it seems to me that Kaiser’s approach is practical. I’d still like to automate everything in my healthcare world, but obviously, that doesn’t work for everyone. Clearly, offline patient management models still matter.

Public Health Agencies Struggle To Integrate With HIEs

Posted on September 21, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

New research by ONC suggests that while public health agencies might benefit from connecting with HIEs, there are still some significant barriers many need to address before doing so.

Public health agencies at both the state and local level collect information from providers as part of conducting disease surveillance activities and maintaining data registries. Though some of these registries are common – notably those focusing on childhood immunizations, birth defects and cancer—the agencies’ technical infrastructure and data formats still vary. This makes sharing data between them difficult.

One alternative to cumbersome data matching between agencies is for the agencies to integrate with an HIE. According to the ONC report, public health researchers have begun to find that at least some of the time, the data they get from HIE organizations is richer than data from clinical systems. Not only that, when public health agencies integrate their information systems with HIEs, it can help them conduct many of their functions more effectively. However, it’s still unusual to find HIE-connected agencies as of yet.

In its new report, ONC outlines what it learned about what the agencies hoped to accomplish with HIE integration and how they moved ahead with integration. To find this out, ONC contracted with Clinovations Government + Health, which participated in discussions with eight entities and analyzing more detailed information on 10 others.

Virtually all respondents had two goals for HIE integration: 1) Minimizing the number of connections needed to link providers, HIEs and agencies and 2) Helping providers meet public health requirements for Medicare and Medicaid EHR incentive programs. A small subset also said that over the longer term, they wanted to create a sustainable platform for clinical and public health exchange which could support enhanced analytics and quality measurement.

Not surprisingly, though, they face considerable challenges in making HIE integration actually happen. In most cases, technology issues were possibly the toughest nut to crack, and almost certainly the most complex. To connect with an HIE, agencies may confront incompatible transport and messaging protocols, standards problems, data classification and coding issues, inconsistent data quality, and their often-inflexible legacy systems, to name just a few of the many problems ONC cites.

As if that weren’t enough, the agencies may not have the funding in place to take on the integration effort, and/or lack a stable funding stream; don’t have the kind of cross-functional leaders in place needed to integrate their systems with HIEs; grapple with complicated patient data privacy and security issues; and bump up against state laws limiting data sharing methods.

However, through its research, the ONC did gather some useful feedback on how the agencies were coping with the long list of HIE integration challenges they face. For example, to win over the support of policymakers, some agencies have emphasized that they’ll be able to use HIE data for higher-level analytics and quality measures. The respondents also noted that HIE integration got more internal support when they got buy-in from top leaders and second-tier leaders have project management, technical and policy skills.

Given these odds, it’s little wonder that the number of public health agencies successfully integrating with HIEs is still small. That being said, there’s good reason for them to keep pushing for integration, so their number is likely to grow over the next few years.

Will Medical Device Makers Get Interoperability Done?

Posted on September 20, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Most of the time, when I think about interoperability, I visualize communication between various database-driven applications, such as EMRs, laboratory information systems and claims records. The truth is, however, that this is a rather narrow definition of interoperability. It’s time we take medical device data into account, the FDA reminds us.

In early September, the FDA released its final guidance on how healthcare organizations can share data between medical devices and other information systems. In the guidance, the agency asserts that the time has come to foster data sharing between medical devices, as well as data exchange between devices and information systems like the ones I’ve listed above.

Specifically, the agency is offering guidelines to medical device manufacturers, recommending that they:

  • Design devices with interoperability in mind
  • Conduct appropriate verification, validation and risk management to ensure interoperability
  • Make sure users clearly understand the device’s relevant functional, performance and interface characteristics

Though these recommendations are interesting, I don’t have much context on their importance. Luckily, Bakul Patel has come to the rescue. Patel, who is associate director for digital health the FDA‘s Center for Devices and Radiological Health, offered more background on medical device interoperability in a recent blog entry.

As the article points out, the stakes here are high. “Errors and inadequate interoperability, such as differences in units of measure (e.g., pounds vs. kilograms) can occur in devices connected to a data exchange system,” Patel writes. Put another way, in non-agency-speak, incompatibilities between devices and information systems can hurt or even kill patients.

Unfortunately, device-makers seem to be doing their own thing when it comes to data sharing. While some consensus standards exist to support interoperability, specifying things like data formats and interoperability architecture design, manufacturers aren’t obligated to choose any particular standard, Patel notes.

Honestly, the idea of varied medical devices using multiple data formats sounds alarming to me. But Patel seems comfortable with the idea. He contends that if device manufacturers explain carefully how the standards work and what the interface requires, all will be well.

All told, If I’m understanding all this correctly, the FDA is fairly optimistic that the healthcare industry can network medical devices on the IoT with traditional information systems.

I’m glad that the agency believes we can work this out, but I’d argue that such optimism may be premature. Patel’s assurances raise a bunch of questions for me, including:

  • Do we really need another set of competing data exchange standards to resolve, this time for medical device interoperability?
  • If so, how do we lend the consensus medical device standards with consensus information system standards?
  • Do we need to insist that manufacturers provide more-consistent software upgrades for the devices before interoperability efforts make sense?

Hey, I’m sure medical device manufacturers want to make device-to-device and device-to-database data sharing as simple and efficient as possible. That’s what their customers want, after all.

Unfortunately, though, the industry doesn’t have a great track record even for maintaining their devices’ operating systems or patching industrial-grade security holes. Designing devices that handle interoperability skillfully may be possible, but will device-makers step up and get it done anytime soon?

Searching EMR For Risk-Related Words Can Improve Care Coordination

Posted on September 18, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Though healthcare organizations are working on the problem, they’re still not as good at care coordination as they should be. It’s already an issue and will only get worse under value-based care schemes, in which the ability to coordinate care effectively could be a critical issue for providers.

Admittedly, there’s no easy way to solve care coordination problems, but new research suggests that basic health IT tools might be able to help. The researchers found that digging out important words from EMRs can help providers target patients needing extra care management and coordination.

The article, which appears in JMIR Medical Informatics, notes that most care coordination programs have a blind spot when it comes to identifying cases demanding extra coordination. “Care coordination programs have traditionally focused on medically complex patients, identifying patients that qualify by analyzing formatted clinical data and claims data,” the authors wrote. “However, not all clinically relevant data reside in claims and formatted data.”

For example, they say, relying on formatted records may cause providers to miss psychosocial risk factors such as social determinants of health, mental health disorder, and substance abuse disorders. “[This data is] less amenable to rapid and systematic data analyses, as these data are often not collected or stored as formatted data,” the authors note.

To address this issue, the researchers set out to identify psychosocial risk factors buried within a patient’s EHR using word recognition software. They used a tool known as the Queriable Patient Inference Dossier (QPID) to scan EHRs for terms describing high-risk conditions in patients already in care coordination programs.

After going through the review process, the researchers found 22 EHR-available search terms related to psychosocial high-risk status. When they were able to find nine or more of these terms in the patient’s EHR, it predicted that a patient would meet criteria for participation in a care coordination program. Presumably, this approach allowed care managers and clinicians to find patients who hadn’t been identified by existing care coordination outreach efforts.

I think this article is valuable, as it outlines a way to improve care coordination programs without leaping over tall buildings. Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence, and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Still, it’s good to know that you can get meaningful information from EHRs using a comparatively simple tool. In this case, parsing patient medical records for a couple dozen keywords helped the authors find patients that might have otherwise been missed. This can only be good news.

Yes, there’s no doubt we’ll keep on pushing the limits of predictive analytics, healthcare AI, machine learning and other techniques for taming wild databases. In the meantime, it’s good to know that we can make incremental progress in improving care using simpler tools.

Willingness To Invest In Outpatient EHRs and PM Solutions Grows

Posted on September 15, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While the ambulatory EHR market remains somewhat stable, the number of organizations preparing to get out of their existing system has climbed over previous years, along with an increase in the number of organizations prepared to upgrade their practice management solution, according to new data from HIMSS.

To conduct the 9th Annual Outpatient PM & EHR Study, HIMSS Analytics reached out to physicians, practice managers/administrators, practice CEOs/presidents, PAs, NPs and practice IT directors/staff. A total of 436 professionals responded to its web-based survey.

The survey concluded that 93% of hospital-owned outpatient facilities had a live, in-operation EMR in place. Meanwhile, 70% of respondents representing free-standing outpatient facilities said they had an EHR in place, down from 78% last year.

As part of its survey, HIMSS Analytics asked respondents whether they planned to purchase an entirely new ambulatory EHR system, replace the existing system upgrade the system within the next two years.

The responses suggest that there’s been some new movement in the ambulatory EHR market. Most notably, 10.6% of respondents said they plan to replace their current solution, up from 6.4% in 2014. This is arguably a significant change. Also, 23.8% respondents said they were upgrading their current ambulatory solution, up from 20.8% in 2014.

In addition, the number of respondents with no investment plans fell below 60% for the first time in four years, HIMSS Analytics noted.

Though the practice management system market seems to be a bit more stable, some churn appears to be emerging here as well. Eleven percent of respondents said they plan to upgrade their current PM solution, down from 20.8% in 2014, and 9.3% said they plan to replace their current system, up from 6.4% in 2014.

All in all, there’s not a great deal of replacement activity underway, though the data does suggest a small spike. That being said, I was interested to note that respondents’ willingness to invest in a new system was higher than their willingness to upgrade a system they have.

The question is, why would ambulatory providers be ready to junk their existing EHR and practice management solutions now as opposed to three years ago? Are we reaching the end of a grand health IT replacement cycle or is there more going on here?

One possibility is that with MACRA kicking in, outpatient providers have been forced to reevaluate their existing systems in terms of their ability to support participation in QPP. Another fairly obvious possibility is that ambulatory providers are choosing to systems they feel can support their movement into value-based care.

From what I can tell, providers choosing new systems for these reasons are actually a bit behind the curve, but not terribly so. When their peers attempt to push forward with their three, four or even five-year-old systems, then you may see a replacement frenzy. Sometimes you just can’t afford to stick with Old Faithful.