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Switching EHRs, The Trends And What To Consider

Posted on September 8, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Winyen Wu, Technology and Health Trend Blogger and Enthusiast at Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Winyen Wu - Stericycle
In recent years, there has been a trend in providers switching Electronic Health Record (EHR) systems: according to Software Advice, the number of buyers replacing EHR software has increased 59% since 2014. In a survey by KLAS, 27% of medical practices are looking to replace their EHR while another 12% would like to but cannot due to financial or organizational constraints. By 2016, almost 50% of large hospitals will replace their current EHR. This indicates that the current EHR products on the market are not meeting the needs of physicians.

What are the reasons for switching EHRs?

  • Complexity and poor usability: Many physicians find that it takes too many clicks to find the screen that they need, or that it is too time consuming to fill out all the checkboxes and forms required
  • Poor technical support: Some physicians may be experiencing unresponsive or low quality support from their EHR vendor
  • Consolidation of multiple EHRs: After consolidating practices, an organization will choose to use only one EHR as opposed to having multiple systems in place
  • Outgrowing functionality or inadequate systems: Some current EHRs may meet stage 1 criteria for meaningful use, but will not meet stage 2 criteria, which demand more from an EHR system.

Which companies are gaining and losing customers?

  • Epic and Cerner are the top programs in terms of functionality according to a survey by KLAS; cloud-based programs Athenahealth and eClinicalWorks are also popular
  • Companies that are getting replaced include GE Healthcare, Allscripts, NextGen Healthcare, and McKesson; 40-50% of their customers reported potential plans to move

What are providers looking for in choosing an EHR?

  • Ability to meet Meaningful Use standards/criteria: In September 2013, 861 EHR vendors met stage 1 requirements of meaningful use while only 512 met stage 2 criteria for certification, according to the US Department of Health and Human Services. Because stage 2 criteria for meaningful is more demanding, EHRs systems are required to have more sophisticated analytics, standardization, and linkages with patient portals.
  • Interoperability: able to integrate workflows and exchange information with other products
  • Company reliability: Physicians are looking for vendors who are likely to be around in 20 years. Potential buyers may be deterred from switching to a company if there are factors like an impending merger/acquisition, senior management issues, declining market share, or internal staff system training issues.

Is it worth it?
In a survey conducted by Family Practice Management of physicians who switched EHRs since 2010, 59% said their new EHRs had added functionality, and 57% said that their new system allowed them to meet meaningful use criteria, but 43% said they were glad they switched systems and only 39% were happy with their new EHR.

5 Things to consider when planning to switch EHRs

  1. Certifications and Compliance: Do your research. Does your new vendor have customers who have achieved the level of certification your organization hopes to achieve? Does this new vendor continually invest in the system to make updates with changing regulations?
  2. Customer Service: Don’t be shy. Ask to speak to at least 3 current customers in your specialty and around your size. Ask the tough questions regarding level of service the vendor provides.
  3. Interoperability: Don’t be left unconnected. Ensure your new vendor is committed to interoperability and has concreate examples of integration with other EHR vendors and lab services.
  4. Reliability and Longevity: Don’t be left out to dry. Do digging into the vendor’s financials, leadership changes and staffing updates. If they appear to be slimming down and not growing this is a sign that this product is not a main focus of the company and could be phased out or sold.
  5. Integration with Current Services: Don’t wait until it’s too late. Reach out to your current providers (like appointment reminders) and ensure they integrate with your new system and set up a plan for integrating the two well in advance.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media:  @StericycleComms

VA May Drop VistA For Commercial EHR

Posted on July 12, 2016 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.

It’s beginning to look like the famed VistA EHR may be shelved by the Department of Veterans Affairs, probably to be replaced by a commercial EHR rollout. If so, it could spell the end of the VA’s involvement in the highly-rated open source platform, which has been in use for 40 years. It will be interesting to see how the commercial EHR companies that support Vista would be impacted by this decision.

The first rumblings were heard in March, when VA CIO LaVerne Council  suggested that the VA wasn’t committed to VistA. Now Council, who supervises the agency’s $4 billion IT budget, sounds a bit more resolved. “I have a lot of respect for VistA but it’s a 40-year-old product,” Council told Politico. “Looking at what technology can do today that it couldn’t do then — it can do a lot.”

Her comments were echoed by VA undersecretary for health David Shulkin, who last month told a Senate hearing that the agency is likely to replace VistA with commercial software.

Apparently, the agency will leave VistA in place through 2018. At that point, the agency expects to begin creating a cloud-based platform which may include VistA elements at its core, Politico reports. Council told the hearing that VA IT leaders expect to work with the ONC, as well as the Department of Defense, in building its new digital health platform.

Particularly given its history, which includes some serious fumbles, it’s hardly surprising that some Senate members were critical of the VA’s plans. For example, Sen. Patty Murray said that she was still disappointed with the agency’s 2013 decision back to call of plans for an EHR that integrated fully with the DoD. And Sen. Richard Blumenthal expressed frustration as well. “The decades of unsuccessful attempts to establish an electronic health record system that is compatible across the VA in DoD has caused hundreds of millions of taxpayer dollars to be wasted,” he told the committee.

Now, the question is what commercial system the VA will select. While all the enterprise EHR vendors would seem to have a shot, it seems to me that Cerner is a likely bet. One major reason to anticipate such a move is that Cerner and its partners recently won the $4.3 billion contract to roll out a new health IT platform for the DoD.

Not only that, as I noted in a post earlier this year, the buzz around the deal suggested that Cerner won the DoD contract because it was seen as more open than Epic. I am taking no position on whether there’s any truth to this belief, nor how widespread such gossip may be. But if policymakers or politicians do see Cerner as more interoperability-friendly, that will certainly boost the odds that the VA will choose Cerner as partner.

Of course, any EHR selection process can take crazy turns, and when you grow in politics the process can even crazier. So obviously, no one knows what the VA will do. In fact, given their battles with the DoD maybe they’ll go with Epic just to be different. But if I were a Cerner marketer I’d like my odds.

Has Electronic Health Record Replacement Failed?

Posted on June 23, 2016 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Galen Healthcare.
Justin Campbell
A recent Black Book survey of hospital executives and IT employees who have replaced their Electronic Health Record system in the past three years paints a grim picture. Respondents report higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits of switching systems. Specifically:

  • 14% of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn’t support the total cost of their replacement EHR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive level respondents admitted they feared losing their jobs as a result of the EHR replacement process
  • 66% of system users believe that interoperability and patient data exchange functionality have declined

Surely, this was not the outcome expected when hospitals rushed to replace paper records in response to Congressional incentives (and penalties) included in the 2009 American Recovery and Reinvestment Act.

But the disappointment reflected in this survey only sheds light on part of the story. The majority of hospitals depicted here were already in financial difficulty. It is understandable that they felt impelled to make a significant change and to do so as quickly as possible. But installing an electronic record system, or replacing one that is antiquated, requires much more than a decision to do so. We should not be surprised that a complex undertaking like this would be burdened by complicated and confusing challenges, chief among which turned out to be “usability” and acceptance.

Another Black Book report, this one from 2013, revealed:

  • 66% of doctors using EHR systems did not do so willingly
  • 87% of those unwilling to use the system claimed usability as their primary complaint
  • 84% of physician groups chose their EHR to reach meaningful use incentives
  • 92% of practices described their EHR as “clunky” and/or difficult to use

None of this should surprise us but we need to ask: was usability really the key driver for EHR replacement? Is usability alone accountable for lost revenue, employment anxiety and buyers’ remorse? Surely organizations would not have dumped millions into failed EHR implementations only to rip-and-replace them due to usability problems and provider dissatisfaction. Indeed, despite the persistence of functional obstacles such as outdated technology, hospitals continue to make new EMR purchases. Maybe the “reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data,” wrote Dr. Donald Voltz, MD in EMR and EHR.

Interoperability is linked to another one of the main drivers of EHR replacement: the mission to support value-based care, that is, to improve the delivery of care by streamlining operations and facilitating the exchange of health information between a hospital’s own providers and the caregivers at other hospitals or health facilities. This can be almost impossible to achieve if hospitals have legacy systems that include multiple and non-communicative EHRs.

As explained by Chief Nurse Executive Gail Carlson, in an article for Modern Healthcare, “Interoperability between EHRs has become crucial for their successful integration of operations – and sometimes requires dumping legacy systems that can’t talk to each other.

Many hospitals have numerous ancillary services, each with their own programs. The EHRs are often “best of breed.” That means they employ highly specialized software that provides excellent service in specific areas such as emergency departments, obstetrics or lab work. But communication between these departments is compromised because they display data differently.

In order to judge EHR replacement outcomes objectively, one needs to not just examine the near-term financials and sentiment (admittedly, replacement causes disruption and is not easy), but to also take a holistic view of the impact to the system’s portfolio by way of simplification and future positioning for value-based care. The majority of the negative sentiment and disappointing outcomes may actually stem from the migration and new system implementation process in and of itself. Many groups likely underestimated the scope of the undertaking and compromised new system adoption through a lackluster migration.

Not everyone plunged into the replacement frenzy. Some pursued a solution such as dBMotion to foster care for patients via intercommunications across all care venues. In fact, Allscripts acquired dBMotion to solve for interoperability between its inpatient solution (Eclipsys SCM) and its outpatient EMR offering (Touchworks). dBMotion provides a solution for those organizations with different inpatient and outpatient vendors, offering semantic interoperability, vocabulary management, EMPI and ultimately facilitating a true community-based record.

Yet others chose to optimize what they had, driven by financial constraints. There is a thin line separating EHR replacement from EHR optimization. This is especially true for those HCOs that are neither large enough nor sufficiently funded to be able to afford a replacement; they are instead forced to squeeze out the most value they can from their current investment.

The optimization path is much more pronounced with MEDITECH clients, where a large percentage of their base remains on the legacy MAGIC and C/S platforms.

Denni McColm, a hospital CIO, told healthsystemCIO why many MEDITECH clients are watching and waiting before they commit to a more advanced platform:

“We’re on MEDITECH’s Client/Server version, which is not their older version and not their newest version, and we have it implemented really everywhere that MEDITECH serves. So we have the hospital systems, home care, long-term care, emergency services, surgical center — all the way across the continuum. We plan to go to their latest version sometime in the next few years to get the ambulatory interface for the providers. It should be very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it,” but we’ll decide when the time is right, she says.

What can we discern from these different approaches and studies?  It’s too early to be sure of the final score. One thing is certain though: the migrations and archival underpinnings of system replacement are essential. They allow the replacement to deliver on the promise of improved usability, enhanced interoperability and take us closer to the goal of value-based care.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

Sansoro Hopes Its Health Record API Will Unite Them All

Posted on June 20, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

After some seven years of watching the US government push interoperability among health records, and hearing how far we are from achieving it, I assumed that fundamental divergences among electronic health records at different sites posed problems of staggering complexity. I pricked up my ears, therefore, when John Orosco, CTO of Sansoro Health, said that they could get EHRs to expose real-time web services in a few hours, or at most a couple days.

What does Sansoro do? Its goal, like the FHIR standard, is to give health care providers and third-party developers a single go-to API where they can run their apps on any supported EHR. Done right, this service cuts down development costs and saves the developers from having to distribute a different version of their app for different customers. Note that the SMART project tries to achieve a similar goal by providing an API layer on top of EHRs for producing user interfaces, whereas Sansoro offers an API at a lower level on particular data items, like FHIR.

Sansoro was formed in the summer of 2014. Researching EHRs, its founders recognized that even though the vendors differed in many superficial ways (including the purportedly standard CCDs they create), all EHRs dealt at bottom with the same fields. Diagnoses, lab orders, allergies, medications, etc. are the same throughout the industry, so familiar items turn up under the varying semantics.

FHIR was just starting at that time, and is still maturing. Therefore, while planning to support FHIR as it becomes ready, Sansoro designed their own data model and API to meet industry’s needs right now. They are gradually adding FHIR interfaces that they consider mature to their Emissary application.

Sansoro aimed first at the acute care market, and is expanding to support ambulatory EHR platforms. At the beginning, based on market share, Sansoro chose to focus on the Cerner and Epic EHRs, both of which offer limited web services modules to their customers. Then, listening to customer needs, Sansoro added MEDITECH and Allscripts; it will continue to follow customer priorities.

Although Orosco acknowledged that EHR vendors are already moving toward interoperability, their services are currently limited and focus on their own platforms. For various reasons, they may implement the FHIR specification differently. (Health IT experts hope that Argonaut project will ensure semantic interoperability for at least the most common FHIR items.) Sansoro, in contrast can expose any field in the EHR using its APIs, thus serving the health care community’s immediate needs in an EHR-agnostic manner. Emissary may prevent the field from ending up again the way the CCD has fared, where each vendor can implement a different API and claim to be compliant.

This kind of fragmented interface is a constant risk in markets in which proprietary companies are rapidly entering an competing. There is also a risk, therefore, that many competitors will enter the API market as Sansoro has done, reproducing the minor and annoying differences between EHR vendors at a higher level.

But Orosco reminded me that Google, Facebook, and Microsoft all have competing APIs for messaging, identity management, and other services. The benefits of competition, even when people have to use different interfaces, drives a field forward, and the same can happen in healthcare. Two directions face us: to allow rapid entry of multiple vendors and learn from experience, or to spend a long time trying to develop a robust standard in an open manner for all to use. Luckily, given Sansoro and FHIR, we have both options.

April Fool’s Day – Health IT Edition

Posted on April 1, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Most of you know that I love a good April Fool’s day joke. I don’t like those that hurt people, but I love good humor (ask me about the time my wife said she was going into labor and wasn’t). You may remember my past years’ pranks about the #HIT100 Health IT Company, the ONC Reality TV show, and my personal favorite where we announced we’d be selling our own EHR software. Good memories all around.

This year I’ve been busy organizing the Health IT Marketing and PR Conference, but that doesn’t mean I can’t enjoy other people’s work. I’m sure I’ve missed some of the great health IT related April Fool’s day jokes, so let me know of others in the comments.

The big winner for April Fool’s 2016 for me was SnapChart from Twine Health. You’ll particularly enjoy it if you’re a SnapChat user, but it’s a great one either way. This video should demonstrate what I mean:

Well done Twine Health! I think even patient privacy advocates would appreciate SnapChart. “We all know that EHRs suck. Well this EHR only sucks for 7 seconds….BOOM”

Another honorable mention goes to Epic who has a long standing tradition of offering something entertaining on April Fool’s Day:
Epic April Fool's Day 2016
*Click on the image to see a larger version

Nice work by Epic to keep it topical with reference to Clinton and Sanders. However, the one that takes the cake is Jonathan Bush using MyChart. The only thing that would make me laugh more would be if athenahealth put out a video response from Jonathan Bush. Please?!

Cureatr decided to go old school with a new technology called the Faxenatr:

Howard Green, MD posted this announcement from Alphabet Inc and Google Inc’s company Verily Life Sciences about the UHIT (Universal Health Information Technology).

So many others I could mention outside of health IT. This one from Samsung about a 3D holographic projection was cool:

Although, when you look at what’s happening with VR, maybe it will be more reality than we realize.

Gmail’s Mic Drop is pretty funny. Well, at least it was until people starting losing their job because of it. The concept of a mic drop on email or social media is pretty interesting though. I wonder if there’s a way you could really implement something like it.

What other April Fool’s day jokes have you seen. It’s Friday. We all need a good laugh.

Expecting Evolutionary, Not Revolutionary at #HIMSS16

Posted on February 26, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, I’m deep in the weeds of planning for the HIMSS 2016 Annual conference. Actually, at this point on the Friday before HIMSS, I’m more or less planned. Now I’m just sitting here and wondering what things I might have missed. With that said, I’ve been preparing for this live video interview with the Samsung CMO which starts in 30 minutes (it’s recorded in case you miss the live discussion) and so I’ve been thinking about what I’m going to see at HIMSS. As someone who follows the changes in healthcare technology every day, I’m expecting lots of evolutionary changes and very little revolutionary.

As I think about it, I’m trying to imagine what someone could announce that would be revolutionary. That includes thinking back to past HIMSS to what announcements really revolutionized the industry. I can only think of two announcements that come close. The first announcement was when the meaningful use regulations were dropped right before the ONC session at HIMSS. Few people would argue that meaningful use has not revolutionized healthcare IT. Certainly many people would argue that it’s been a revolution that’s damaged the industry. Regardless of whether you see meaningful use as positive or negative, it’s changed so many things about healthcare IT.

The second announcement that stands out in my mind was the CommonWell health alliance. I’m a little careful to suggest that it was a revolutionary announcement because years later interoperability is still something that happens for a few days at the HIMSS Interoperability showcase and then a few point implementations, but isn’t really a reality for most. However, CommonWell was a pretty interesting step forward to have so many competing EHR companies on stage together to talk about working together. Of course, it was also notable that Epic wasn’t on stage with them. This year I’ve seen a number of other EHR vendors join CommonWell (still no Epic yet), so we’ll see if years later it finally bears the fruits of what they were talking about when they announced the effort.

The other problem with the idea that we’ll see something revolutionary at HIMSS 2016 is that revolutions take time. Revolutionary technology or approaches don’t just happen based on an announcement at a conference. That’s true even if the conference is the largest healthcare IT conference in the world. Maybe you could see the inkling of the start of the revolution, but then you’re gazing into a crystal ball.

The second problem for me personally is that I see and communicate with so many of these companies throughout the year. In just the last 6 months I’ve seen a lot of the HIMSS 2016 companies at various events like CES, RSNA, MGMA, AHIMA, etc. With that familiarity everything starts to settle into an evolution of visions and not something revolutionary.

Of course, I always love to be surprised. Maybe someone will come out with something revolutionary that changes my perspective. However, given the culture of healthcare and it’s ability to suppress revolutionary ideas, I’ll be happy to see all the amazing evolution in technology at HIMSS. Plus, the very best revolutionary ideas are often just multiple evolutionary ideas combined together in a nice package.

What’s Happening at MEDITECH w/ Helen Waters, VP @MEDITECH

Posted on January 25, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE: Here’s the video recording of my interview with Helen Waters from MEDITECH

MEDITECH - Helen Waters

Many in the large hospital EHR space have argued that it’s a two horse race between Cerner and Epic. However, many forget how many users MEDITEH still has using its healthcare IT products. Not to mention MEDITECH was originally founded in 1969 and has a rich history working in the space. On Friday, January 29, 2016 at 1 PM ET (10 AM PT), I’ll be sitting down with Helen Waters, VP at MEDITECH to talk about the what’s happening with MEDITECH and where MEDITECH fits into the healthcare IT ecosystem.

You can join my live conversation with Helen Waters and even add your own comments to the discussion or ask Helen questions. All you need to do to watch live is visit this blog post on Friday, January 29, 2016 at 1 PM ET (10 AM PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’ll be doing a more formal interview for the first 30 minutes and then open up the Blab to others who want to add to the conversation or ask us questions. The conversation will be recorded as well and available on this post after the interview.

We’re interested to hear Helen’s comments about the culture and history of MEDITECH along with what MEDITECH’s doing with its products to change perceptions and misconceptions around the MEDITECH product. We’ll also be sure to ask Helen about important topics like interoperability and physician dissatisfaction (“Too Many Clicks!”). We hope you’ll join us to learn more about what’s happening with MEDITECH.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

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 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 and 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

HIM Departments Need More Support

Posted on July 16, 2015 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.

As both a contributor to this blog, and an assertive, activist patient managing chronic conditions, I get to see both sides of professional health information management.  And I have to say that while health data management pros obviously do great things against great odds, support for their work doesn’t seem to have trickled down to the front lines.  I’m speaking most specifically about Medical Records (oops, I mean Health Information Management) departments in hospitals.

As I noted in a related blog post, I recently had a small run-in with the HIM department of a local hospital which seems emblematic of this problem. The snag occurred when I reached out to DC-based Sibley Memorial Hospital and tried to get a new log-in code for their implementation of Epic PHR MyChart. The clerk answering the phone for that department told me, quite inaccurately, that if I didn’t use the activation code provided on my discharge summary papers within two days, my chance to log in to the Johns Hopkins MyChart site was forever lost. (Sibley is part of the Johns Hopkins system.)

Being the pushy type that I am, I complained to management, who put me in touch with the MyChart tech support office. The very smart and help tech support staffer who reached out to me expressed surprise at what I’d been told as a) the code wasn’t yet expired and b) given that I supplied the right security information she’d have been able to supply me with a new one.  The thing is, I never would have gotten to her if I hadn’t known not to take the HIM clerk’s word at face value.

Note: After writing the linked article, I was able to speak to the HIM department leader at Sibley, and she told me that she planned to address the issue of supporting MyChart questions with her entire staff. She seemed to agree completely that they had a vital role in the success of the PHR and patient empowerment generally, and I commend her for that.

Now, I realize that HIM departments are facing what may be the biggest changes in their history, and that Madame Clerk may have been an anomaly or even a temp. But assuming she was a regular hire, how much training would it have taken for the department managers to require her to simply give out the MyChart tech support number? Ten minutes?  Five? A priority e-mail demanding that PHR/digital medical record calls be routed this way would probably have done the trick.

My take on all of this is that HIM departments seem to have a lot of growing up to do. Responsible largely for pushing paper — very important paper but paper nonetheless — they’re now in the thick of the health data revolution without having a central role in it. They aren’t attached to the IT department, really, nor are they directly supporting physicians — they’re sort of a legacy department that hasn’t got as clearly defined a role as it did.

I’m not suggesting that HIM departments be wiped off the map, but it seems to me that some aggressive measures are in order to loop them in to today’s world.

Obviously, training on patient health data access is an issue. If HIM staffers know more about patient portals generally — and ideally, have hands-on experience with them, they’ll be in a better position to support such initiatives without needing to parrot facts blindly. In other words, they’ll do better if they have context.

HIM departments should also be well informed as to EMR and other health data system developments. Sure, the senior people in the department may already be looped in, but they should share that knowledge at brown bag lunches and staff update sessions freely and often. As I see it, this provides the team with much-needed sense of participation in the broader HIT enterprise.

Also, HIM staff members should encourage patients who call to log in and leverage patient portals. Patients who call the hospital with only a vague sense that they can access their health data online will get routed to that department by the switchboard. HIM needs to be well prepared to support them.

These concerns should only become more important as Meaningful Use Stage 3 comes on deck. MU Stage 3 should provide the acid test as to whether whether hospital HIM departments are really ready to embrace change.

Meaningful Use EHR Adoption Charts – EHR Market Analysis

Posted on June 12, 2015 I Written By

John Lynn is the Founder of the 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 and 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.