Yesterday I had the opportunity to talk with the people from GE who briefed me that GE is in the process of shutting down their GE Centricity Advance product line. This was pretty big news to me since I remember just last year at HIMSS meeting with GE and hearing that for the small practice (I believe 1-10 docs) GE Centricity Advance was where they were putting all their effort. You could see the energy they had behind it. In fact, their iPad EHR app was built on top of the GE Centricity Advance solution (which is now being moved to their other EHR product lines).

You might remember that the GE Centricity Advance solution was actually created out of the purchase of MedPlexus in March 2010. At the time, MedPlexus had 100 employees out of California with the development team out of India. At the time of purchase it seemed GE’s acquisition would provide a SaaS based EHR option to the independent physician market. Plus, MedPlexus (which became GE Centricity Advance) also provided an integrated Practice Management System with the EHR.

The GE Centricity Advance website is already forwarding to the Centricity Practice Solution website and a letter was sent out to all Centricity Advance customers informing them that the product line was ceasing operation. I’ve asked for a copy of that letter and if I get it, I’ll add it to this post (or if you’re a customer that received it and doesn’t mind sharing we’d welcome it).

I was told that GE is offering Centricty Advance users a free transfer to their Centricity Practice Solution EHR software. From what they told me it seems this will include data migration, training on the new system and a license for Centricity Practice Solution. Of course, Centricity Advance was paid on a subscription model so they’ll have to continue paying the monthly fee. As with most data migrations, I don’t think we’ll know how good GE is at migrating the data from GE Centricity Advance to Centricity Practice Solution until they start to do them.

Since both Centricity Advance and Centricity Practice Solution have ONC-ATCB complete EHR certification, there shouldn’t be any problems for those that transfer to Centricity Practice Solution when it comes to EHR stimulus money. Those not wanting to move to the Centricity Practice Solution will have this as part of their decision on what to do once Centricity Advance is no longer supported. I expect there will be many in this situation since while Centricity Practice Solution is available through GE’s partners as a “SaaS” offering, I think many will want to find a true from the ground up web based SaaS EHR offering.

I asked how many providers would be effected by the end of the Centricity Advance product line, but it’s GE’s policy to not comment on those numbers.

Where does this leave GE Centricity EMR software?
GE Healthcare IT still does a couple billion dollars of business and still has three EMR software offerings:
*Centricity Practice Solution – The replacement for Centricity Advance and will be GE’s EMR offering for the 1-100 provider practices.
*Centricity EMR – Still ambulatory EMR, but for the 100+ provider practices.
*Centricity Enterprise – Acute care EMR

I’m sure that many will wonder how good the Centricity Practice Solution will do in the small practice arena. Will this basically mean that GE is no longer a player in the small 1-10 provider practices? It’s hard to say for sure, but I’ll be interested to see how the Centricity Practice Solution EHR does in this market. There must have been a reason they purchased what became Centricity Advance instead of going with Centricity Practice Solution in the first place.

On the other hand, I could see people making the argument that this is a sound strategy by GE since movements like accountable care organizations (ACO’s) and related initiatives are putting the small practice in jeopardy. We know that many hospital systems are purchasing up group practices as they prepare to become an ACO among other reasons. While we still have many small group practices, it’s worth considering how many of them will survive the changing landscape. If not many survive, then this strategy by GE could end well for them. Although, I personally believe that practice consolidation is cyclical and so I’m not ready to announce the death of small group practices yet.

Another trend that might make this a good decision on GE’s part is what I call the Smart EHR. Our current phase of EHR adoption is basically converting paper to electronic. Once doctors start requiring EHR software to do things far more advanced (see Artificial Intelligence and Genomics EHR), it will require a new kind of EHR. Maybe Centricity Advance wasn’t prepared to make this shift. We’ll see if GE’s other EHR software is ready for it.

Many have argued that EHR consolidation is inevitable. I guess I shouldn’t be surprised that part of that EHR consolidation is happening within the same EHR company. I’m sure there are more on the way as we see which EHR companies survive the meaningful use winter and come out on the other side and which EHR companies close up shop.

Update: I asked GE for some more clarification on when GE Centricity Advance would be sunset and which data they’ll be migrating as part of the data migration process. Here are their answers:
Sunset Period: We have announced that we will cease operations of Centricity Advance on June 30, 2012. The data will be available in read-only mode until December 31, 2012.

Data Migration: We are working with our partners and customers to figure out the best way to migrate data. We have told customers that we will migrate the following data:
a. Patient Demographics, Patient Insurance data, Fee Schedules, Appointments
b. Patient Summary
c. Patient chart
We will migrate all clinical data. We are working with our partners to determine which financial information should be automatically migrated.

Chuck Podesta is Fletcher Allen Health Care’s chief information officer.

ICD-10 would not be so daunting if the deadline was not occurring during the rush to get EHRs for meaningful use. Add in value-based purchasing, bundled payments and transitioning to ACOs, and you can see why many CIOs are retiring early or migrating to the vendor or consulting world. We are just over two years away from the October 2013 deadline, and there is much work to be done. ICD-10 contains 68,000 codes, as opposed to the 13,000 currently used in the ICD-9 world. There is a code for every condition that exists on the planet.

The revenue cycle system, which includes registration, HIM and billing/AR, will be the lynch pin to ICD-10 readiness. Having a solid vendor partner and a strong product is key to a successful transition. Many solution providers – like GE Healthcare, who recently launched the 5.0 version of their Centricity Business product – are updating their systems to better comply with ICD-10. GE Healthcare also allows existing Centricity Business customers to retrofit the new ICD-10 functions to the 4.6 version of the product. Strong vendor partners take the burden off you by being ahead of the game and delivering the appropriate technology in time so you are not racing to the finish line.

By now, you should have at least a steering committee in place. Your IT shop should have completed an inventory of all applications that are impacted by ICD-10, including reporting systems. You will be surprised by the number of applications, even if you have taken the one-vendor approach for most of your IT needs. You will need to contact all affected application vendors to see what the plans are for ICD-10 compliance. Most likely, upgrades will be required that will need to be scheduled.

Training of coders will be critical, along with implementing clinical documentation improvement programs. Documentation improvement programs are difficult to implement and will be viewed by providers as more work on top of an already busy schedule. New technologies such as computer-assisted coding will definitely help, but success will be a combination of process improvements and technology.

Lastly, remember that the deadline is for Medicare and Medicaid patients only. Unless the rest of the payer industry follows the same deadline (highly unlikely), you will need to run both ICD-9 and ICD-10 systems.

John’s Note: The following is a guest post by Mark Segal talking about the recently announced ACO program and it’s relationship to EHR, meaningful use, and healthcare IT. I also love the insider look at rule making.

The long-awaited proposed rule on Medicare’s Shared Savings Program (SSP)/Accountable Care Organization (ACO) program is out. These 429 pages outline how the Administration plans to transform U.S. health care delivery from fee-for-service to a value-based emphasis on accountability for quality and efficiency of care provided for populations. Following a final rule later this year, the program is to start January 1, 2012, with additional January 1 annual starts by ACOs, and a special optional start possible for July 1, 2012 given the tight timing this year.

CMS solicits comments on program design areas. The final rule will certainly track the proposed rule in key aspects, but there could be important changes based on comments – although revisions must be within the scope of proposed rule options because CMS cannot add new concepts in the final rule.

Care coordination, patient centeredness and evidence-based medicine are major priorities. As expected, therefore, health information technology (HIT) and electronic health records (EHRs) will be central to ACO success.  In some cases, HIT is cited explicitly; for example at least 50 percent of ACO primary care physicians must be meaningful users of EHRs in an ACO’s second year.

In other cases, CMS, focusing on patient engagement, care coordination, and care transitions, highlights HIT capabilities an ACO should address in its SSP application. For example, CMS calls out using EHRs and health information exchange (HIE) to send care summaries at care transitions.  In addition, CMS flags HIT areas like telehealth and remote monitoring, evidence-based medicine, and measuring physician performance across practices and using measurements to improve care and service. Also, HIT will be central to the need to report on and achieve desired levels (after year one) of many of the 65 quality measures.  For example, HIT could help reduce levels of healthcare-acquired conditions.

CMS’s HIT approach is non-prescriptive.  An ACO must address, in its application, how it would address such requirements as care coordination (including use of HIT) but CMS does not dictate technology tools or specific features.   Fundamentally, CMS is outcomes-focused, looking at up-front plans and then focusing on ACO ability to meet quality metrics and overall efficiency goals.  Such flexibility contrasts with meaningful use, which is highly prescriptive.  ACOs will have flexibility to design and deploy their HIT strategies.  Overall, such flexibility should also be considered as the HIT Policy Committee, ONC and CMS consider requirements for Stage 2 of meaningful use, especially for newer areas of HIT use.

Finally, of concern, and relevant also to the need for multi-year meaningful use roadmaps, CMS reserves the right to annually change the SSP during three-year ACO agreements.  Although CMS excludes some areas from such annual changes, this uncertainty is worrisome given the substantial investments and organizational changes that must be made by ACOs.  Three years is a blink of the eye in care transformation; ACOs need regulatory stability and predictability to plan and invest with confidence and to succeed at the change management that will underlie ACO success.

So read carefully and submit timely comments!

Mark Segal is the vice president of government and industry affairs at GE Healthcare IT.