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Department of Defense (DoD) EHR Project Opens Doors for HIT Vendors and Non-Vendors – Breakaway Thinking

Posted on August 19, 2015 I Written By

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
Numerous medical advances can be traced back to development and research conducted by the U.S. military. In most instances, these developments were directly related to mitigating casualties and disease during times of war. The U.S. Civil War is seen as one of the most influential military events to advance modern medicine. Life-saving amputations, anesthesia, thoracic surgery, wound treatment, facial reconstruction, and the inception of the ambulance-to-ER transport system all originated with military intervention. While today’s medical advancements have certainly surpassed anything ever imagined by Civil War surgeons a century and a half ago, the model of healthcare innovations spurring from military initiatives remains steadfast. In fact, the U.S. military is one of the largest payers and providers within the modern day healthcare system, and the Department of Defense’s (DoD) current Electronic Health Records (EHR) project presents an unparalleled opportunity for development and implementation of an innovative solution that will inform advancement in both the military and private health systems. With this DoD decision, the contracted vendors will have opportunities and challenges to fulfill the reality of this EHR, and all other vendors will have an opportunity to innovate and capitalize on the private sector.

While the massive undertaking to update the DoD’s EHR system holds great promise, many health information technology experts have expressed skepticism surrounding the approach and associated costs of implementation via a complex public-private partnership model. Skeptics also continue to point to the failed implementation of HealthCare.gov as a litmus test for potential success. Potential pitfalls aside, the DoD EHR project does create opportunity for health information technology (HIT) vendors and start-ups across the industry who recognize that disruptive innovation can easily erupt in the private sector, and new market opportunities will arise as a result of this government-private sector partnership. Both critics and supporters should pay attention to the developments in the coming months.

The DoD contract will likely span 10 years with the aim of creating a new electronic health system to replace the DoD’s Armed Forces Health Longitudinal Technology Application (AHLTA). This collective effort, referred to as the Defense Healthcare Management System Modernization (DHMSM),  or “Dimsum” as commonly called by health IT insiders, creates opportunity for development of a commercial, off-the-shelf version of the government system. The price tag for this contracted venture is $4.34 billion, but that certainly may increase as development evolves. Compared to prior attempts by the DoD and the U.S. Department of Veterans Affairs (VA) to create an integrated electronic health record at an estimated costs of $28 billion, the $4.34 billion price tag appears to offer staggering savings; however, the two projects differ greatly. The initial integrated EHR was scrapped due to cost estimates and disagreement between DoD and VA leadership, ultimately leading to DHMSM and the VA moving forward with a separate update to that EHR, which later became known as the Veterans Health Information Systems and Technology Architecture (VistaA) program.  Despite leadership disagreements and technological difficulties, one of the goals of DHMSM is interoperability between the new DoD system and the VA system.

Dr. Jonathan Woodson, assistant secretary of defense for health affairs, articulated the need for interoperability between both military and private systems during a July 29 briefing. He stated that the goal is for the new military system and the private sector systems to become interoperable. If private sector health IT vendors – whether partners in the contract or not – figure out how to easily exchange data and communicate with other platforms, they will truly capitalize on this opportunity and improve care simultaneously.

Interoperability between private and military systems is underway. For example, the Military Health System in Colorado Springs, Colorado joined efforts with the Colorado Regional Information Organization (CORHIO) and is making progress with interoperability and data sharing through the utilization of Health Information Exchanges (HIEs). They are able to share patient information and data in both private and military health systems. As presented at this years’ HIMSS conference, the initial collaboration and efforts between the two organizations have shown promising results.

Dr. Karen DeSalvo, federal health IT coordinator, echoes further support and enthusiasm for DHMSM and private system interoperability. “[The DHMSM is] an important step toward achieving a nationwide interoperable health IT infrastructure.” As contributors to the Office of the National Coordinators Interoperability Roadmap, Dr. Karen DeSalvo and her cohorts appreciate the potential impact of establishing interoperability on such a large scale. It will be an incredible milestone in HIT history to attain true interoperability of military and private systems. Conversely, if large-scale interoperability is not achieved, it may lead to more spending and potentially the demise of the project altogether. To the chagrin of DHMSM supporters, this failure would only support assertions that the failed Healthcare.gov website was only the beginning of a litany of government HIT challenges. But given the track record of medical advances related to military research and development, the DHMSM project will likely achieve some level of interoperability and attain the goals set during the initial request-for-proposal phase.

The next opportunity and challenge is already happening. The selected DHMSM health IT vendors must maintain their private sector customer base while rapidly developing the new military system. This is no small task. Doing so will require additional resources and new partnerships to successfully manage this effort. It also means that if these vendors are not successful, their customer base may decide to switch EHRs and implement another EHR platform altogether. Either way, there are opportunities for HIT vendors and consultants to innovate and gain entry to new markets and customers.

Alternatively, the HIT vendors not selected for the DHMSM contract are positioned to innovate and create new technologies and supporting systems. Although the military is responsible for many medical advances, numerous technological advances have been developed in the private sector and can be traced to simple beginnings in a garage or dorm room without any direct military or government involvement. Those across the HIT marketplace have the opportunity and motivation to develop new, cutting-edge technology, by capitalizing upon the bright light currently being shone on new health technologies as a means of improving patient safety and health outcomes.

Data security is another area to pay attention to in the coming months. The DHMSM is an excellent opportunity to develop sophisticated systems to protect patient health information. Conversely, creating such a massive interoperable system opens up risk for data security of all integrated systems. In an age where devices, web searching, and systems leave a trail of bread crumbs and create an internet-of-things (ioT) or web of data points, the new DHMSM system must effectively protect this web of data to avoid compromising personal and national security.

We must also consider the ability to successfully implement and adopt the DHMSM system. This type of system will require a coordinated and focused effort of massive proportions. After coordinating logistics, adopting the new system will require another heroic level of effort. Difficulties may lie in establishing proper governance between the selected HIT vendors and military projects and ensuring that all companies involved have the stamina and focus for the entire life cycle of the system. The DoD began laying the foundation for governance structures during the initial proposal process, but it is yet to be seen if all involved parties will be able to adhere to the outlined parameters and work collaboratively to create their new DHMSM system. Additionally, once the system is designed and implemented, if proper funds are not available to sustain the system, the DoD would have to consider a potential redesign.

The military’s track record with medical advances positions them to successfully implement the new DHMSM system. Remarkably, this project has the potential to lay the foundation for interoperability and data security in the U.S. Despite the obvious challenges associated with the DHMSM EHR project, a system that is able to communicate and safely share data for large populations is worth the investment. From a global perspective, many countries are far ahead of the U.S. in designing and implementing national health records (e.g. Denmark, Finland, Sweden, UK, and Australia). There is also the potential for the DHMSM system to evolve one day into a national electronic health record, but doing so would require a national paradigm shift and lot more than $4.3 billion. Additionally, the challenges associated with this initial venture will surely be exacerbated due to the scale of the project and sheer importance. Health IT vendors and start-ups not directly involved in DHMSM should remain optimistic and on the lookout for new opportunities and challenges on the horizon. If the DoD and the contracted health IT vendors can successfully develop and deploy the DHMSM system, new opportunities, research and medical advances will likely follow.  It’s up to both HIT vendors and non-vendors of the DoD contract to decide whether they walk through this “door” of opportunity and make the most of this historic initiative.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Cerner, Leidos, and Accenture Win DoD EHR Project – $4.3 Billion

Posted on July 30, 2015 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.

All the news at the end of the day yesterday was around Cerner (and their major partners Leidos, Accenture) winning the DoD EHR project. We’d been told the decision would come by the end of the month and you knew a decision was close once the major news organizations started writing about what a waste the DoD EHR project will be before they’d even named the winner. That’s called priming the pump. Of course, the critics make some good points about the DoD EHR project dealing with today instead of the future, and they also suggested that “We’re going to make Epic or Cerner the Standard Oil of health IT. It will become a monopoly at a time when we need to be moving to solutions that allow everyone to participate.”

I guess now that we know that Cerner has won the DoD contract, does that make them the Standard Oil of Health IT?

What we do know is that Cerner, Leidos, and Accenture were awarded the $4,336,822,777 (Our government’s so precise they got a 10 year project down to the dollar?) EHR contract with it projected to be around $9 billion over the life of the 10 year contract. That’s massive by any terms. It’s also much less than the projected $11 billion that was previously discussed. I guess competition for the DoD EHR contract brought the price down? Although, how often does the government project the costs for a project and then they balloon over the life of the project. According to Healthcare IT News, they’ll be working on bringing their first sites live in the Pacific Northwest by the end of 2016 and 1000 sites by 2022.

A lot of people have been commenting how this is a big win for Cerner and a big loss for Epic. Of course, I wrote a little over a year ago that the best thing for Epic might be to NOT win the DoD EHR contract. You can be sure that many hospital systems won’t be selecting Cerner now that they’re going to be tied up with the massive DoD EHR contract. Who does that leave? In most cases, that will leave Epic. I can’t help but wonder how many Soarian users will now decide to go to Epic instead of Cerner as well because of the Cerner win. Cerner should start working on this potential perception problem.

You can imagine the celebrations happening at the companies that won this contract. HIStalk posted a great image that shows all the partners that will be involved in the bid:
DoD EHR Partners

While they may be celebrating the contract now, it reminds me of startup companies who do big celebrations when they raise a round of funding. Those celebrations are premature since it’s really the start of all the hard work to come.

I personally lean more towards G Gordon Liddie’s comment on the HIStalk post on this subject:

Cerner will do as good a job as Epic would have done…which won’t be great. The federal government can’t pull off something like this.

I think this shares many people’s fears of a project this size. Others might suggest, if the government can’t roll out an insurance exchange website without major issues, how are they going to make an EHR roll out which is much more complex a success. I’m sure Cerner, Leidos, and Accenture will be thinking about this every day for the next 5-10 years.

Other DoD EHR Coverage:
Healthcare IT News
nextGov
HIStalk
MedCityNews

Meaningful Use EHR Adoption Charts – EHR Market Analysis

Posted on June 12, 2015 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.

ONC continues to push out more data when it comes to meaningful use, EHR adoption, RECs, and related areas. As a data addict, I could spend forever looking through and analyzing this data. So, I’ll probably do a series of posts across Healthcare Scene over the next couple weeks looking at the charts and data that ONC has made public about meaningful use and EHR adoption. I know some of the charts have been out for a while, but the analysis should still prove useful.

If you want to join in on the analysis of this data, I welcome you in the comments of each post. Plus, if you want to find your own nuggets to share, I’d suggest starting with their quick stats and dashboards pages.

First up in our look at the ONC EHR data is a look at the meaningful use participation chart for ambulatory EHR vendors (eligible providers if you prefer):
Ambulatory Practice EHR Adoption - Meaningful Use Participation
The most important part of this chart to me is that the two largest bars on the chart. The largest bar is the 749 “Other EHR Vendors” category at the bottom of the chart. It’s easy to miss this bar, but I believe it’s extremely important to note how big the long tail is when it comes to ambulatory EHR adoption. I’ve often said that it doesn’t take that many doctors to make yourself a decent EHR business. This chart illustrates how many EHR vendors are still in the game. There are only 3 EHR vendors that have over 40,000 providers. I know that many think that EHR vendor consolidation is bound to happen. Some certainly will, but I don’t see it happening at a massive scale in the ambulatory EHR world.

The second largest bar on the chart is the Epic EHR adoption. What’s important about this bar is that this totally represents that hospital owned ambulatory EHR adoption. Epic does not and will not sell Epic directly to a small ambulatory provider. All of these “eligible providers” for Epic are in hospital systems. I take away two important things from this. First, we see in plain sight how big the roll up of ambulatory practices is by hospitals. Second, this chart illustrates the opportunity that Cerner and Meditech have available to them. As you’ll see in the next chart, Cerner and Meditech have more hospital installs than Epic, but they’re much farther down on the ambulatory side. A look at history explains why they’ve had trouble penetrating the ambulatory market, but I believe it’s a huge opportunity for them going forward.

I’ll be interested to see how this chart continues to evolve over time. Will we doctors leaving hospitals to go back on their own shift the balance of power? Will we see massive EHR consolidation? I also can’t help but note that Mitochon Systems Inc shows up on the list and they don’t even sell an EHR to doctors directly any more. I assume this must be their white label business? I’ll have to follow up with them to get an update on their business.

Now let’s take a look at the chart for Hospital EHR vendors participating in the EHR incentive programs:
Hospital EHR Adoption - Meaningful Use Participation
This chart illustrates really well the 3 horse hospital EHR race which we’ve all known for a while. Although, given healthcare IT’s love affair with Epic (kind of like Apple in the IT world), I think some will be a bit surprised that Cerner and MEDITECH are both listed ahead of Epic. If you looked only at large hospital systems, I think the chart would look very different though.

It’s worth also mentioning the other horses in the race: McKesson, CPSI, MEDHOST, Healthland and Allscripts. They’ve all carved out their niche in the hospital space. We’ll see if they can continue to defend their territory. Hospital EHR switching is not easy.

My favorite observation from this chart versus the ambulatory chart is how well it illustrates the importance of secondary EHR vendors (the brownish gold color) in hospitals. I’ll never forget when Alan Portela of Airstrip told me that the EHR world will be a heterogenous environment. That absolutely resonated with me and this chart proves out what he said. Health systems are going to have multiple EHR vendors even if some EHR vendors would like it to be otherwise.

If you want to look at the potential disruptors in the world of EHR, I’d take a look at these secondary EHR vendors. Their foothold in hospitals provides them a really great opportunity to disrupt the status quo as we know it. Most of them won’t, but they’re all sitting on an opportunity. I’d start with the companies that make up the “Other Vendors” brownish gold bar. I bet there are some really interesting ones in that list.

I’d love to hear your observations from these charts in the comments. Anything I missed? Do you disagree with my observations? I look forward to hearing your thoughts.

HL7 Backs Effort To Boost Patient Data Exchange

Posted on December 8, 2014 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.

Standards group Health Level Seven has kicked off a new project intended to increase the adoption of tech standards designed to improve electronic patient data exchange. The initiative, the Argonaut Project, includes just five EMR vendors and four provider organizations, but it seems to have some interesting and substantial goals.

Participating vendors include Athenahealth, Cerner, Epic, McKesson and MEDITECH, while providers include Beth Israel Deaconess Medical Center, Intermoutain  Healthcare, Mayo Clinic and Partners HealthCare. In an interesting twist, the group also includes SMART, Boston Children’s Hospital Informatics Program’s federally-funded mobile app development project. (How often does mobile get a seat at the table when interoperability is being discussed?) And consulting firm the Advisory Board Company is also involved.

Unlike the activity around the much-bruited CommonWell Alliance, which still feels like vaporware to industry watchers like myself, this project seems to have a solid technical footing. On the recommendation of a group of science advisors known as JASON, the group is working at creating a public API to advance EMR interoperability.

The springboard for its efforts is HL7’s Fast Healthcare Interoperability Resources. HL7’s FHir is a RESTful API, an approach which, the standards group notes, makes it easier to share data not only across traditional networks and EMR-sharing modular components, but also to mobile devices, web-based applications and cloud communications.

According to JASON’s David McCallie, Cerner’s president of medical informatics, the group has an intriguing goal. Members’ intent is to develop a health IT operating system such as those used by Apple and Android mobile devices. Once that was created, providers could then use both built-in apps resident in the OS and others created by independent developers. While the devices a “health IT OS” would have to embrace would be far more diverse than those run by Android or iOS, the concept is still a fascinating one.

It’s also neat to hear that the collective has committed itself to a fairly aggressive timeline, promising to accelerate current FHIT development to provide hands-on FHIR profiles and implementation guides to the healthcare world by spring of next year.

Lest I seem too critical of CommonWell, which has been soldiering along for quite some time now, it’s onlyt fair to note that its goals are, if anything, even more ambitious than the Argonauts’. CommonWell hopes to accomplish nothing less than managing a single identity for every person/patient, locating the person’s records in the network and managing consent. And CommonWell member Cerner recently announced that it would provide CommonWell services to its clients for free until Jan. 1, 2018.

But as things stand, I’d wager that the Argonauts (I love that name!) will get more done, more quickly. I’m truly eager to see what emerges from their efforts.

Avoiding The EMR Alienation Effect

Posted on February 10, 2014 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.

Recently, I stumbled across a very interesting article talking about I call the “patient alienation effect” generated by EMRs.  The author, Charles Smith, who practices at the University of Arkansas, is an EMR old hand who has been using the Centricity ambulatory EMR for more than a decade.

The article, which appears in the Journal of Participatory Medicine, talks about the well-known offputting effect EMRs have on patients, and the frustration that they impose on doctors. And as readers know, we’re not talking about a minor impact here.

In the new EMR world, he notes, physicians have a list as long as your arm of EMR related tasks they must perform during the patient visit, including medication reconciliation, managing the problem list, e-prescribing, updating the patient’s history, review of systems, physical exam, entering the follow-up plan into the record, and printing “after the visit” summaries for the patient. And as he points out, this all has to happen for the patient is still sitting in the exam room.

The way he handles this problem is to treat the challenge is one for the patient and physician to solve things together:

*  At the outset, he and the patient have an open discussion of the EMR issue with new patients, discussing the advantages and challenges of the computer in the room.

*  Then, he asks the patient’s to allow him to move their chair beside him in the computer, noting that they will “all three” work together during the visit.

* He also tries to create a hybrid experience of completing some EMR tasks during the visit and others after (for example telling the patient, “hold on while I enter this order for you) before returning to face-to-face conversation.

* He finds that it works best to take notes here and there during the patient visit, then complete the past medical, surgical, family and social history and the review of systems together with the patient directly in the EMR.

Obviously, there’s no one right way to integrate patients into the process of documenting their visit in an EMR. But these ideas seem like good ones.

One Platform to Connect to All EHR Software

Posted on February 6, 2014 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.

I’ve talked for years with people who want to solve the problem of connecting their non-EHR software to all the EHR vendors out there. Entrepreneur after entrepeneur has asked me how they can connect their product to ALL the EHR vendors. It usually ends up being a question like, “Isn’t there just one company we could connect to that will connect us to all the EHR vendors out there?”

I’ve dreamed about this as well. In fact, I recently wrote a post on Hospital EMR and EHR titled “Meaningful Use Drove the Data Gathering” where I suggest things like “EHR data is a treasure trove of opportunity.” and “In the future, EHR vendors will be differentiated more on the marketplace of third party applications they support than on their own in house developed apps.”

The problem is that even if every EHR vendor were to open up their application to third party applications, a startup company doesn’t want to have to integrate with all 300+ EHR vendors out there. Instead, they’d much rather integrate with one company who can connect them to all the other EHR vendors.

While a simple solution to connect to every EHR isn’t available yet, In a recent chat with Thanh Tran, Founder of Zoeticx, he showed me the closest thing to this vision that I’ve seen.

This slide shows what Zoeticx has built so far and a little bit of their vision for the future. When I saw this slide, it looked very much like what I described above.
Zoeticx Data Platform

As the slide shows, it only connects to 4 EHR vendors (5 EHR software) right now. So, they still have a lot of work to do to make this model work across all 300+ EHR vendors. However, it displays a vision of what’s possible if a company like Zoeticx builds the right middleware to connect EHR software to third party software.

After talking with Thanh Tran, you could tell that he lived, breathed, and loved the middleware space. He understood what it took to build a great middleware. For example, Zoeticx has a number of applications that leverage the middleware that they’re building. Some might argue that this makes Zoeticx a product company and not a middleware company. However, those that say this don’t understand what it takes to make great middleware.

By Zoeticx having some applications which leverage their middleware, they accomplish a couple very important things. First, they are essentially “eating their own dog food” and get to see first hand the challenges of building an application that uses their middleware. This will improve the middleware product better than any other technique. Second, Zoeticx applications will serve as essentially a set of demo applications which can be used to demonstrate what’s possible. Without these essentially demo applications, it’s often hard for people to understand how an API like Zoeticx can be used.

Certainly it’s possible that the Zoeticx application business is so good that they don’t go after the middleware opportunity. However, knowing Thanh’s background makes me think that this is an unlikely possibility. He wants Zoeticx to be a middleware company.

Thanh Tran also said something really intriguing about the latest EHR that they connected to their universal patient clinical data model (Zoeticx Patient Clarity). He said that when they added the new EHR, they didn’t have to change the Zoeticx Patient Clarity side of the equation at all. I’ll be interested to see how this plays out as they connect to more and more EHR vendors.

In fact, I believe that’s the next key step for Zoeticx. They need to connect with the other EHR vendors. Although, my guess is that once they get enough momentum behind what they’re doing, then they can provide an API for EHR vendors and other software vendors to create a gateway to Zoeticx. Then, they’ll have something really powerful.

It’s still early for Zoeticx. We’ll see how they do at attracting third party applications to their platform. We’ll see how their gateways to EHR vendors go and how they’re able to scale up the number of EHR vendors they work with. However, their vision gave me some hope that we could have a simple model for entrepreneurs that want to connect their health IT software with multiple EHR software with one integration.

4 Reasons U.S. EMR Firms Won’t Try China

Posted on October 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

If you have something to sell, chances are you’ve thought about selling it in China.

With a population of 1.35 billion, it’s become an attractive market for U.S. companies pushing everything from athletic shoes to light trucks to Tide. Given the natural limits of their home market, you’d assume that American EMR firms would eventually size up China’s nascent health IT scene.

And it’s likely they have. In a report a few years ago, 100 percent of vendors surveyed told the consulting firm Accenture that they saw global markets as an opportunity in the long term.

But health IT doesn’t export quite as easily as Pringles and KFC. I’ve seen China’s healthcare system up close several times, and if you ask me, making headway in the world’s most populous nation will be beyond difficult.

China, which is in the midst of its own health care reform, could certainly be tempting for companies such as Epic, McKesson and Cerner. As Benjamin Shobert wrote for Forbes, the country in 2009 extended basic health coverage to 97 percent of its citizens. It also promised to build 31,000 hospitals, upgrade 5,000 existing ones and train 150,000 new primary-care doctors.

McKinsey & Co. last year said health care spending in China would grow to $1 trillion in 2020 from $375 million in 2011.

Meanwhile, U.S. EMR companies are going to need new markets to conquer. Estimates of how much growth potential is left are many and varied. But no matter how you look at it, at some point every American healthcare organization of any size will have an EMR. Millennium Research Group last month predicted declining EMR-industry revenue from this year on because of “market saturation.”

Of course, plenty of IT firms, including Oracle and IBM, have a major presence in China. But the China market won’t happen in a significant way for U.S. health IT companies any time soon, and here’s why:

  • China’s healthcare is different. The private physician’s office that Americans are used to is more or less nonexistent. You go to a hospital-based clinic and see the doctor who’s available. Patient privacy hasn’t taken hold, so there could be other clinic-goers and family members milling about near — or in — your exam room. Chinese traditional medicine is practiced alongside the “Western” variety. Even with insurance, you typically pay up front and get reimbursed later. A U.S.-centric EMR would not map neatly onto China’s workflows. There’s an overview of China’s system here. I’ve written about a Chinese dental clinic here.
  • No one understands China’s health IT. OK, I’m sure some people do, and I hope they comment. But it’s a challenge. The health information firm KLAS Enterprises isn’t even attempting to cover China. A KLAS executive vice president, Jared Peterson, told Modern Healthcare, “The Chinese market, that’s a big mystery.” Meanwhile, Accenture omitted China from its 2010 report “Overview of International EMR/EHR Markets” because of “conflicting opinions of overall EMR maturity.”
  • The language barrier will be formidable. Epic CEO Judith Faulkner told Modern Healthcare how her company had adapted its system for another language. “We’ve only done it once, for Dutch,” she said in January 2012. “It’s a lot of mapping. It’s a task, but it hasn’t been that bad of a task.” But Dutch is not Chinese, and Chinese doesn’t use the Roman alphabet. I’m betting that when you throw Chinese characters into the mix, the conversion will be “that bad of a task” and then some.
  • Cloud-based systems could raise security issues. Some experts expect cloud-based services to play a significant role as health IT spreads to developing countries. But according to a U.S.-China Economic and Security Review Commission report, “Regulations requiring foreign firms to enter into joint cooperative arrangements with Chinese companies in order to offer cloud computing services may jeopardize the foreign firms’ information security arrangements.”

It’s worth mentioning that three years ago, China was mentioned as Cerner announced plans to develop global markets. It wanted to get into emerging regions before its U.S.-based competitors did.

There’s not much sign of life now in any China-related plans the company might have had, though. According to a message from Chad Haynes, managing director for Cerner Asia, on the firm’s website: “We look forward to improving the health of communities in ASEAN, China, and beyond.”

In the case of China, that could be a while.

Intermountain Chooses Cerner, International EMR, and Patient Focused EMR

Posted on September 29, 2013 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.


This was really big news this week. I’m not sure it’s quite a turning point for EMR. I think we’re still early in the war, but this was a big battle for Cerner to win. We’ll see what GE decides to do after losing this deal. Will GE leave this business behind or buy another vendor?


I think we don’t look nearly enough at the international EMR experience. We could learn a lot in the US from what’s happening nationally. Plus, for many EHR vendors the international opportunity is a big one that most don’t even consider.


I’ve been preaching this for so long I can’t remember. I know there are EHR vendors that focus as much as they can on the patient, but compliance and reimbursement still means you have to make compromises. That’s not an indictment of those companies, but a reality of the situation.

EMR Market Share

Posted on July 18, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Editor’s Note: This is the first post on EMR and HIPAA by James Ritchie. James is a longtime journalist including the past eight years as a staff writer with the Cincinnati Business Courier.

Practice Fusion announced in June that it led the EMR industry in market-share gains.

Citing SK&A reports, the San Francisco-based firm boasted that it controlled 5.8 percent of the market as of May, up from 3.8 percent in July 2012. Beyond Practice Fusion, only Epic, AthenaHealth and Cerner showed gains.

In this data, which represents physician offices only, Allscripts was the market leader, with a 10.6 percent share. Not far behind were eClinicalWorks, with a 10.5 percent share, and Epic, with 10.3 percent. (The report that Practice Fusion links to is actually dated January 2013.)

But there’s more than one way to look at the EMR share picture.

Epic was the clear winner in a report by the Austin, Texas-based consultancy Software Advice on meaningful use attestations. Epic, based in Verona, Wis., accounted for 20.3 percent of attestations for a complete EHR in an ambulatory setting.

The firm’s competitors were nowhere close as of the March 2013 report. Allscripts was the system of choice for 11.6 percent of attestations by eligible professionals, and eClinicalWorks accounted for 8 percent. Next on the list were NextGen Healthcare, GE Healthcare and, with 2.7 percent share, Practice Fusion.

Software Advice claimed that the figures, based on Centers for Medicare and Medicaid Services data, might be the best around. They at least provide a standard in a market where vendors “use varied criteria to calculate their customer base,” according to the company.

Companies “might count number of users (which could include everyone from physicians to administrative staff), number of medical providers (which could include everyone from physicians to midwives) or number of practices,” Software Advice noted on its website.

Practice Fusion, founded in 2005, claimed in its press release to have doubled both its monthly active user base of medical professionals and its patient population between 2012 and 2013. The company claims to reach “a community of 150,000 medical professionals serving 65 million patients.”

The prospects for the free model that Practice Fusion uses are still up in the air. Doctors might question whether they want ads, unobtrusive as they are at the bottom of the screen, to compete for their attention when they’re entering patient data. Data, by the way, might prove to be the real revenue generator for Practice Fusion. In June the firm launched Insight, an analytics product offering a population-level view of diagnoses, prescribing patterns and other information. It’s a model worth watching. If Facebook and google can build businesses on data, maybe Practice Fusion can, too.

The SK&A figures show just how fragmented the outpatient EMR/EHR market is. The top 10 vendors accounted for only 64.8 percent of attestations, leaving about 35 percent of the market to the “other” category. By Software Advice’s count, 560 firms logged at least one meaningful use attestation.

Eager to steal share are firms like Irvine, Calif.-based Kareo Inc. It launched its own free, cloud-based EHR in February based on technology acquired from San Mateo, Calif.-based Epocrates Inc. The firm reported in June that 4,000 providers had signed on, with a third of them moving from another EHR.

Of course, ambulatory adoption is only part of the EMR story.

Epic is No. 1 among the nearly 3,000 hospitals that have received federal incentives for using complete electronic records systems, according to Modern Healthcare. The company holds a 19.6 percent share, followed by Computer Programs and Systems Inc. with 15.5 percent, Meditech with 14.1 percent and Cerner with 11 percent. The late-May report was based on numbers from CMS and the Office of the National Coordinator for Health Information Technology.

The inpatient market is far less fragmented than the outpatient space. The top 10 companies control 92 percent of share, according to the report.

No matter how you count share, the EMR space will continue to be hypercompetitive because of the dollars at stake. The market amounted to $20.7 billion in 2012, up 15 percent from 2011, according to the research firm Kalorama Information.

Cerner Supports Blue Button +

Posted on July 5, 2013 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.

Cerner has announced plans to support and participate in the Blue Button + initiative, marking a small step towards freer sharing of patient health information by its clients.

Blue Button +, launched as the Automate Blue Button Plus Initiative, is the next generation version of the Blue Button technology for consumer download of health information. This next gen Blue Button is intended to provide a blueprint for better-structured and secure transmission of personal health data.

What this announcement means in practical terms, according to an entry in Cerner’s blog, is that the EMR giant will make it possible for its Cerner Direct clients to securely zap information to any personal health record participating in Blue Button +.  Cerner Direct users will also be able to send automated reminders to people managing specific health conditions or who need age/gender-specific check-ups, plus send out summaries of care and instructions following a health visit.

Cerner Direct, as readers probably guessed, uses standards drawn from the Direct Project, a set of standards and documentation allowing providers to push data from one point to another. Cerner has obtained accreditation from the Direct Trusted Agent Accreditation Program offered by DirectTrust and the Electronic Healthcare Network Accreditation Commission.

And why is Cerner taking this step? “The primary goal we have for our clients is to help create a trusted, reliable group of participants with which to securely exchange health care information using Direct protocols over the open internet, helping them reduce their liabilities by creating an efficient, secure method of communication based on best practices,” writes Andy Heeren of Cerner.

This sounds like a reasonable move toward greater data interoperability, if not an earthshaking one. It will be interesting to see where Cerner takes this.