Time to go through some interesting Tweets from the world of EMR and EHR.

@glevin1 – gary levin
Commodization of EMR | HealthWorks Collective

There was a link on this tweet too, but it looked like a link to a page that stole the content from the original article. I’ve been intrigued by the question of whether EMR is a commodity software or not for a while now. I still haven’t come to a firm conclusion. This article uses the idea that you can buy Allscripts MyWay at Costco as a way to say that EMR is a commodity. You can also buy eCW at Sam’s Club I believe. Although, as best I can tell, that was basically a PR move on the various EHR vendors part.

Also, the article says that Allscripts MyWay product came from the purchase of Misys. Actually, I think MyWay was originally Aprima. I believe the Misys EHR software is set to be sunset.

What do you think? Is EMR a commodity?

@BrianSMcGowan – Brian S. McGowan PhD
Percent of US PCPs using EMR = 17% in ’00′ – 28% in ’06′ – 46% in ’09′ (vs 99% in Netherlands) #socialQI #progress??

The link on this one was to a terribly long PDF file. So, I cut it out. I just wish I knew where Brian got his numbers. I call BS on the US having 46% EHR adoption in 2009. I still put us at about 25% EHR adoption now. Maybe a little higher if I’m being generous. Of course, a lot of people define EHR a lot of different ways. So, that might be part of the issue.

@DRZORBA – Zorba Paster
Back to the clinic. Everyone brings their records with them. No EMR here. If they lose their record then they’re @*%&M.

Hmm…imagine a world where the doctor didn’t keep any record. The patient was just responsible for the record. That idea is fraught with trouble and issues, but I bet many doctors would love to not have to worry about the records part of their job.

@medreccom – Medical Records
“Paper is dangerous and inefficient, it doesn’t belong in health care any longer.” Future of #EMR: on.mash.to/uhVkHn

I was interested in this tweet since it linked to an article on Mashable (a mainstream tech site). So, if I get this right, this article and series was sponsored (ie. paid for) by Lenovo and profiles Practice Fusion. In other words, Lenovo paid to advertise Practice Fusion on Mashable. Good for Practice Fusion. Although, I’m not sure how many doctors read Mashable. Maybe the article wasn’t about finding doctors, but was a way to find more tech people to come work at Practice Fusion. The article itself is pretty basic for someone that reads this site. Not a bad play if that was the intent. Full Disclosure: Practice Fusion advertises on this site. Although, they certainly didn’t pay me to write about this and link to it.

Time for my roundup of interesting topics seen throughout the interwebs and related to EHR and healthcare IT.

@Allscripts
Astounding growth in use of EHRs – 5x in 2.5 yrs – Dr. Mostashari at #ACE2011 (via Skype) – does your doc use an EHR?

I’d like to see where Dr. Mostashari got those numbers. I think there’s little doubt that EHR use is up. If we say that 2.5 years ago it was at about 15%, then that would mean that using his growth number we’re now at 75%. That seems way too high for me.

@shelleypetersen – Michelle Petersen
US are starting to standardise vendor requirements for #healthit and language used in #EHR regions, important move

Is this a misread of what’s being done with meaningful use and EHR certification? I haven’t seen standards really emerge for most of this. I guess it does say “starting.”

Hospital EMR User Tracking Bill
Don’t ask me why, but this post about a CA Bill Requiring Hospital EMR Software to Track Users came across my tweet stream as well even though it was posted back in June. I guess that’s one thing I love about Twitter. It can bring back interesting content that you wouldn’t have seen otherwise.

After reading the post, I wondered if the CA bill passed or not. I’m guessing not. Although, I’m still shocked by the article’s comments that even an expensive Epic install at Kaiser can’t meet the requirements of reporting on what data for a patient in an EHR has been deleted and who’s accessed that patient data.

MGMA Conference in Las Vegas
I’ll admit that I’ve wanted to go to the MGMA conference for a couple years now. This year I’m lucky that it’s hosted in the beautiful Las Vegas. So, I’ll definitely be there enjoying the event. I’ve been thinking about doing a New Media Meetup at MGMA like I do at HIMSS. Are any readers interested if I put it together? If there’s only a few of you, we could just do a dinner or something. Let me know in the comments or on my contact us page.

Ever since the American Recovery and Reinvestment Act became law in February 2009, giving birth to the phrase “meaningful use,” I’ve wondered when private insurers would follow the federal government’s lead and start offering financial carrots and sticks for using and not using EHRs. After all, one of the purposes of the Medicare and Medicaid incentive program was to address the fact that payers tend to reap the greatest financial gains from hospitals and physicians adopting EHRs, even though most if not all of the cost of acquiring the technology falls on the provider.

Federal officials have made it clear all along that “meaningful use” is just that, the meaningful use of the technology. The government was not simply going to write checks so providers could go out and buy technology. As the country’s largest purchaser of  healthcare services, CMS wanted some value for its money (not exactly something you hear every day when it comes to government spending).

I’d been hearing for years that major commercial health insurers also were willing to share some of the savings from EHR adoption, but not until the largest payer of them all, Medicare, did so first. The private sector usually does follow Medicare’s lead when it comes to major policy shifts. Medicare now has done so, but private payers have been mostly silent. Mostly.

This month, as InformationWeek reports, Humana teamed up with Allscripts Healthcare Solutions to offer physician practices financial incentives for purchasing Allscripts EHR systems. The deal is similar to one Humana cut last year with Athenahealth. A few Blue Cross and Blue Shield plans, notably in Massachusetts and Rhode Island, have led similar programs at the state level, with eClinicalWorks the main partner.

But unless I’m forgetting something, Humana is the only big payer that has jumped into the game. Where are the UnitedHealthcares, Aetnas, Cignas and WellPoints of the world?

Payers, it’s time to make good on the lip service you gave years ago and start passing on some of the savings you will realize from Medicare, Medicaid and hundreds of thousands of providers spending billions of dollars on EHR technology and health information exchange efforts.

Many of you probably already saw the announcement of the $500 million contract that was signed between Allscripts Healthcare Solutions and ACS, A Xerox Company, to provide hosted IT service for the Allscripts’ Sunrise Enterprise Suite. Considering the size of the contract, I thought it would be interesting to do an interview to learn more about the Allscripts and ACS (Xerox) relationship.

The following is an email interview with Lee Shapiro, President, Allscripts and Chad Harris, Executive Vice President and Group President, ACS Healthcare Provider and IT Applications Solutions. They duck a few of the questions, but provide some information about their relationship that I think’s useful and interesting.

Lee Shapiro, president, Allscripts

What percentage of Allscripts Sunrise Enterprise Suite customers use the hosted model vs. in-house servers?
There are approximately 50 remote hosted clients.

Why did Allscripts choose to outsource the hosting after having the infastructure in place?
As the payment paradigm in healthcare shifts and our clients’ growing and complex needs around new regulatory requirements continue to evolve, ACS, A Xerox Company will support Allscripts as it scales to deliver service levels required for diverse healthcare settings.

Immediately ACS will begin to focus on standardizing and optimizing our operational processes, help to manage our Service Level Agreements on system availability and enhance our recovery and security capability.

This alliance also helps us deliver faster client case resolution. Longer term, it will enable us to deliver a richer toolset, broader set of monitoring capabilities, access to geographic data centers and new services. Allscripts will still have a remote hosting business and will continue to manage all aspects of the alliance and client relationships. Data is always available whether it is remotely hosted or not.

Do you expect to outsource the hosting of MyWay and other Allscripts hosted EMR products to ACS down the road as well?
Allscripts is always evaluating options to provide the best service support for its growing and diverse customer base.  Right now, our ACS alliance is the best solution to meet current and projected needs.  We will continue to evaluate.

Are you concerned that customers will have issues with having to work with two large companies?  Instead of “one neck to ring” they will have multiple companies that can point the “proverbial finger” at the other.
Allscripts is excited about this partnership and the response has been overwhelmingly positive. We will continue to manage the client relationship at every level, including sales and support and will also provide our healthcare industry domain expertise in partnership with ACS’s world class remote hosting infrastructure.  This is a single solution for our clients.  It is an exciting combination.

What share of the 96 providers using these remote hosting services are hospital versus ambulatory?
Allscripts has not entered to an agreement with ACS on ambulatory.

Chad Harris, executive vice president and group president, ACS Healthcare Provider and IT Applications Solutions

Describe how the transition of hosting will occur for existing customers.
The transition of hosting services will be seamless for Allscripts customers. From a governance perspective, Allscripts will continue to have a direct relationship with hosted clients, handling overall client relationship management activities including fielding service requests and projects, reporting, invoicing, and sales support.

ACS, A Xerox Company, will run and maintain the current systems by assuming responsibility for day-to-day technical delivery and data center operations, and supporting Allscripts in its continued service of new and existing hosted customers.

As part of the arrangement, ACS maintains the existing Allscripts data centers under what is commonly referred to as a facilities management agreement.  ACS will optimize the data center footprint and technical environment overtime under a structured long term plan involving no impact to the clients.  Additional capacity will be provided to support growth and expansion via ACS’ global data center and operations network.

ACS will introduce industry standard best practices, new tools and other forms of automation, as well as additional services including advanced recovery to improve service excellence, performance and reliability of the hosting operation.

Will Xerox be bringing their expertise in printing and scanning to this relationship as well or only their hosting operations?
While Xerox technology is not specifically part of the current hosting engagement, ACS is investing in a Healthcare Innovation Lab for Allscripts to evaluate integration of new technologies, cloud computing solutions and  client-specific deployment and testing initiatives. In addition, ACS and Allscripts will form an Innovation Council to evaluate future technologies and work processes that will help Allscripts support the changing needs of providers.

After the recent Amazon cloud hosting outages, what’s ACS and Allscripts doing to make sure similar outages don’t occur?
The Allscripts application environments are critical patient care systems and as such require an architecture that supports a very high level availability and performance. Under the new hosting partnership, ACS will work with Allscripts to maintain and improve application uptime and operational resiliency through a high availability architecture and advanced recovery capability. High availability is achieved through the deployment of failover technology, or methods, that ensure system availability and transaction protection. The most common configuration utilizes the active/passive clustering approach.

The Sunrise Clinical Manager (SCM) application is cluster aware and is configured in a clustered environment. ACS utilizes the high availability clustering supported by SCM application servers to ensure that all single points of failure are resolved and the application can quickly return to service after a loss of the primary server

Likewise, says Allscripts’ Tullman, “today we’re building the operating system for the future of healthcare. This country can’t afford its healthcare system anymore, so something’s got to change. We can no longer buy our way out of the problem.” – Source: Information Week

The above comments sparks all sorts of interesting thoughts and questions for me. The first is “What is the Operating System of healthcare IT?” Obviously, we’re quite sure Tullman hopes that it’s the suite of Allscripts products. Although, how ironic is it that one company can have 5-10 (I lost count) different EMR software. I’ve never known an operating system to have 5-10 completely different software. Seems like something needs to change there. Unless you want to say that various segments of healthcare IT are going to have different operating systems.

I do feel like EHR software is the operating system of healthcare IT. It’s going to be the basis upon which many other software packages are built on.

I imagine the above statement is probably why Tullman made the comment and the comparison. Allscripts has an ambitious project (although I haven’t seen many results yet) to create a kind of app eco system for healthcare IT apps. There are other vendors that do the same. For example, I know that SRSsoft has open API’s that allow developers to extend their apps. I love this movement in the EMR world. My biggest challenge is identifying the application developers that are interested and willing to leverage these APIs. That part of the app ecosystem seems to be missing to me.

My next thought is that similar to how we didn’t realize how beneficial an application like Excel would be until we had the operating system that facilitated its creation. Who is going to create an Excel like app that can run on the EMR operating system and provide benefits to claims processing, clinical decision support, diagnosis help, insurance billing, etc etc etc. Certainly it’s possible that the O/S (EMR) developers will make a lot of these applications, but I won’t be surprised if the EMR is just the platform that allows other smart people to innovate on a particular subject.

In my time writing about EMR, one thing has been very clear. You can’t be all things to all people. An EMR vendor that embraces, supports and creates a strong healthcare IT application developer community would cause me to take notice above the noise.

While some might consider the following commentary an ad for Quest Diagnostic’s Care360 EHR, it’s not. I don’t even have them as an advertiser. Plus, you could easily submit a number of other companies name in the place of Quest. However, the following were some thoughts I had after talking with the people behind Care360 EHR at Quest.

First, let me clarify some name issues so we’re all on the same page. Quest Diagnostics is the company. It’s publicly traded on the NYSE with the ticker DGX. Most of you will know about Quest since they’re one of the leading lab companies in the US. MedPlus is the subsidiary within Quest that covers the healthcare IT portion of the company including their EMR software. Care360 is the name of their SaaS EHR software which they sell. Although, Care360 is also used to provide lab results amongst other functions as well.

Now why am I talking about Care360 and Quest? I find it completely fascinating that a company like Quest is part of the EHR landscape. Certainly we have plenty of large and even many publicly traded companies that already provide an EHR, but I see some potential differences between Quest and many of these companies.

One of the biggest fears that doctors have when selecting an EHR company is that they’re afraid of how long that company will be around. Even in the cases of very large companies, there’s still the fear that the large EHR company might get bought out or merged into another company and the EHR software will be left on life support (see Misys being bought by Allscripts for an example). This is a reasonable fear that should be considered during the EMR selection process.

I believe that Quest and Care360 EHR has a distinct advantage in this regard. Quest is not likely to go out of business or even sell off their EHR software to another company. In fact, their Care360 EHR is so tightly coupled with the rest of Quest’s lab services, I’m not sure it would even be possible for Quest to sell off their EHR software if they wanted to do it.

That’s not to say that something couldn’t happen to Care360 that would make Quest change their direction. They could essentially “sell” their users to another EHR vendor through some sort of referral process or they could just choose to shutdown that division of the company because it wasn’t profitable. However, you can be quite sure that they’ll be interested in the transition process. At least if you’re a Quest lab customer. They’re not going to want to lose lab customers because they decided to stop doing EHR.

This is only one factor related to selection of an EMR (see my free EMR selection e-Book for more). There should be some discussion related to how tied you are to Quest if you use their EHR. For example, I can’t remember if Care360 has an interface with LabCorp or not. You might even ask yourself if a Lab company can make great EHR software. They also don’t have a practice management system, but said they’d consider creating one in the future.

It’s like most things in life. There’s pros and cons to everything. You could certainly argue some of the other benefits of going with Quest and Care360 EHR. For example, Quest’s been doing the SaaS based model with their Care360 lab results for a while on a very large scale. They have some expertise in that regard which they can carry over into their EHR product.

Now the question I’m interested in finding out is, what is Labcorp’s approach to EHR?

I still have a hard time calling myself a writer or even press (although it’s convenient for getting into conferences). Plus, I think I reach, influence and interact with as many or more people than the traditional healthcare journalist. However, there’s something liberating about being called a blogger instead of a journalist because the standard and approach is different.

At least I thought that was the case until I read this article on Forbes.com which declares Allscripts new API as “Open Source’s Debut in Healthcare.” Ok, to be fair, it was written written on a Forbes healthcare blog and not their magazine, but as a blogger I’m embarrassed that a Forbes blogger would write such a terrible article.

Let me set the record straight. Allscripts launched an interesting API (which they call an “Application Sote & Exchange”). It’s a sort of app store for healthcare IT. This is interesting news and worthy of a story. What it’s not is open source entering healthcare.

Maybe there is some sliver of open source software that’s part of the Allscripts API/App store (or maybe not), but that’s backed by a heavy set of proprietary Allscripts software. It’s not like Allscripts has open sourced their MyWay or Allscripts Professional EHR. Then, you could really talk about Allscripts entering the open source EMR world. This is NOT!

Besides the fact of saying that is open source when it’s not, is the blogger’s headline that this is the first open source in health care. That’s just absolutely silly. Here’s just a few of the Open Source EMR on the EMR and HIPAA wiki page that have been around for quite a while and led I believe by OpenEMR and the various flavors of Open Source Vista EMR.

Honestly, Zina Moukheiber should be embarrassed by what she wrote. Even a blogger should be held to a higher standard than what she wrote. Of course, the sad part is that her mistakes likely drove a ton of traffic to the post. It’s her top post with 51 people tweeting the post and 15 people sharing it on Facebook. Too bad she lost all credibility in the process so the short term spike won’t turn into long term readers.

Pamela sent me the following EMR stimulus question in response to my post about Doctor’s having no choice with meaningful use:

Can we show meaningful use without a certified EMR or would we still be penalized since our EMR vendor has no intention on becoming certified?

The current HITECH law requires meaningful use of a certified EHR. So, you have to use a certified EHR to get the EMR stimulus money and to avoid the Medicare penalties. They have been looking at doing site certifications so you could show that you’ve put together everything to satisfy the certified EHR portion. However, so far I’ve only seen the site certification really apply to hospitals. I haven’t seen a site certification for smaller doctors offices (yet?).

Just be aware that some are suggesting that the penalties will never be imposed. Basically, they say that ONC will just keep delaying those penalties for one reason or another and that they’ll never actually be enforced. Plus, don’t be surprised if they make exceptions for certain medical specialties. For example, if not a single chiropractor (or some small number) shows meaningful use of a certified EHR, then it seems reasonable that ONC could look at making an exception for those specialty groups.

It’s also worth taking a look at this post I did which gave an example of the EMR stimulus Medicare penalties. They don’t amount to as much as you’d think.

I imagine we’ll see quite a few faced with this situation. This will become even bigger when some EMR vendors decide to deal with meaningful use stage 1, but choose not to prepare for meaningful use stage 2. Allscripts will be doing this with their now sunsetted EMR acquisition, Peak Practice. Basically, they’re going to make it work for meaningful use stage 1, but then users will have to switch to a different Allscripts EMR for meaningful use stage 2. That will make for a tough decision for someone who has to switch EMR software to get more stimulus money and avoid the penalties.

I have a strong feeling that EMR and HIPAA is going to make a switch from talking about selecting and implementing EMR to switching EMR software over the next 5 or so years. Not a fun subject for providers to consider, but many are actually doing it now.

As I mentioned in my previous post about the race to be the first EHR certified (and the first ATCB to certify an EHR), there’s a lot more going on in the battle amongst the EHR certifying bodies.

The first interesting detail surrounds the previous CCHIT certified EHR vendors. This turns out to be a really great move by CCHIT. A quick look at CCHIT’s website has 49 EHR products (or modules of products) that have been certified for either the CCHIT 2011 certification or for the Preliminary ARRA certification. That’s 49 pieces of EMR software (a few less since some are different versions of the same product) have paid $22k+ in order to be certified by CCHIT.

I’ve talked to one of these EHR vendors and they said that CCHIT did a call with all current vendors and said that they will be honoring their previous commitment to provide the real ARRA certification at no additional cost to these providers. This turns out to be really smart if it means that many of the big EHR players like GE, Elipsys/Allscripts, NextGen, Epic, Athena, Pulse, Cerner, etc all decide to continue forward with CCHIT.

Many would ask why they would pay another $20k to someone like Drummond Group if they could get the EHR certification for free from CCHIT. Turns out their is a possibility if CCHIT isn’t able to deliver their certification in a timely manner and Drummond Group is able to do it much quicker.

Remember the list above are HUGE EHR vendors where $20k is basically a drop in the bucket. It’s kind of scary to consider that, but that’s the reality for most of the EHR vendors. Sure, it’s not what they’d like to spend if they don’t have to, but when did large corporations start worrying about wasteful spending? Ok, that might be a slight exaggeration, but you get the point.

The good thing for Drummond Group is that there are still 300+ EMR vendors that will need to be certified. In fact, many of the non CCHIT certified EHR companies are likely moving to Drummond Group for EHR certification since CCHIT is giving priority to their existing EHR vendors.

Yes, that’s right. Over the next month and half CCHIT will spend all its time doing a bunch of free EHR certifications while Drummond Group will be making just under $20k for each EHR certification that they do.

One final thought about the fun that is EHR certification. When I recently talked to an EHR vendor that is CCHIT certified and will likely be getting their now free EHR certification, I found it really interesting to learn who from their company was on the CCHIT call. In this case, the EHR vendor’s VP of Marketing was on the call with CCHIT.

Of course, this begs the question why the VP of Marketing would be on a call about EHR certification standards and compliance. Shouldn’t the clinical director be the one that wants to be on that call? I think it sends a compelling message that I’ve been preaching on EMR and HIPAA for a long time. EHR certification is not a benefit to the doctor. EHR certification is not a benefit to the patient. EHR certification is a means for EHR vendors to market their EHR software.

I’m going to be a little lazy today and just give you a couple links to the story of yesterday. I guess I get busy sometimes too. In case you missed it, the BIG news yesterday was Allscripts acquisition of Eclipsys.

I posted most of the relevant links on EMR and EHR yesterday along with some interesting user comments about the deal. Also, if you like this stuff, you’ll enjoy this lengthy analysis that was done on HISTalk about the acquisition.

Here’s my thoughts after reading the HISTalk analysis:
“After this merger, the new company will be trying to support eight EMRs systems and five practice management solutions with a sprinkling of inpatient technology”

Talk about an ugly situation. Plus, this quote doesn’t even highlight all the HIE software they’re dealing with.

I ran into a number of unhappy Misys users who were angry for Allscripts making them change. Just wait for these Allscripts resellers who are going to have to deal with the MyWay fall out.