Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Please, No More HIE “Coming Of Age” Stories

Posted on September 29, 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.

Today I read a Modern Healthcare story suggesting that health information exchanges are “coming of age,” and after reading it, I swear my eyes almost rolled back into my head. (An ordinary eye roll wouldn’t do.)

The story leads with the assertion that a new health data sharing deal, in which Texas Health Resources agreed to share data via a third-party HIE, suggests that such HIEs are becoming sustainable.

Author Joseph Conn writes that the 14-hospital system is coming together with 32 other providers sending data to Healthcare Access San Antonio, an entity which supports roughly 2,400 HIE users and handles almost 2.2 million patient records. He notes that the San Antonio exchange is one of about 150 nationwide, hardly a massive number for a country the size of the U.S.

In partial proof of his assertion that HIEs are finding their footing, he notes that that from 2010 to 2015, the number of HIEs in the U.S. fluctuated but saw a net gain of 41%, according to federal stats. And he attributes this growth to pressure on providers to improve care, lower costs and strengthen medical research, or risk getting Medicare or Medicaid pay cuts.

I don’t dispute that there is increased pressure on providers to meet some tough goals. Nor am I arguing that many healthcare organizations believe that healthcare data sharing via an HIE can help them meet these goals.

But I would argue that even given the admittedly growing pressure from federal regulators to achieve certain results, history suggests that an HIE probably isn’t the way to get this done, as we don’t seem to have found a business model for them that works over the long term.

As Conn himself notes, seven recipients of federal, state-wide HIE grants issued by the ONC — awarded in Connecticut, Illinois, Montana, Nevada, New Hampshire, Puerto Rico and Wyoming — went out of business after the federal grants dried up. So were not talking about HIEs’ ignoble history of sputtering out, we’re talking about fairly recent failures.

He also notes that a commercially-funded model, MetroChicago HIE, which connected more than 30 northeastern Illinois hospitals, went under earlier this year. This HIE failed because its most critical technology vendor suddenly went out of business with 2 million patient records in its hands.

As for HASA, the San Antonio exchange discussed above, it’s not just a traditional HIE. Conn’s piece notes that most of the hospitals in the Dallas-Fort Worth area have already implemented or plan to use an Epic EMR and share clinical messages using its information exchange capabilities. Depending on how robust the Epic data-sharing functions actually are, this might offer something of a solution.

But what seems apparent to me, after more than a decade of watching HIEs flounder, is that a data-sharing model relying on a third-party platform probably isn’t financially or competitively sustainable.

The truth is, a veteran editor like Mr. Conn (who apparently has 35 years of experience under his belt) must know that his reporting doesn’t sustain the assertion that HIEs are coming into some sort of golden era. A single deal undertaken by even a large player like Texas Health Resources doesn’t prove that HIEs are seeing a turnaround. It seems that some people think the broken clock that is the HIE model will be right at least once.

P.S.  All of this being said, I admit that I’m intrigued by the notion of  “public utility” HIE. Are any of you associated with such a project?

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.

Hospitals, Representative Ask For Extension of EMR “Safe Harbor”

Posted on April 3, 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.

Right now, it’s legal for hospitals to give doctors EMRs under certain circumstances, despite the existence of the Stark law banning payments intended to induce referrals.  Specifically, hospitals won’t face anti-kickback enforcement if doctors pay 15 percent of the cost of EMRs donated by hospitals.

But the Stark law exception established by CMS, plus a “safe harbor” rule established by the HHS Office of the Inspector General, are both due to expire at the end of 2013. This will take place despite the fact that Medicare incentives for EMR adoption will continue through 2016, notes iHealthBeat.

Hoping to address this state of affairs, the Federation of American Hospitals has made the renewal of EMR exceptions to the Stark law its top recommendation in a proposed list of safe harbors, reports Modern Healthcare. More recently, Rep. Jim McDermott (D-Wash.) wrote a letter to the chief counsel to HHS’ OIG to extend those exceptions soon.

Extending these safe harbor provisions at least through the life of the Meaningful Use program seems necessary and wise. After all, it’s hard enough to get smaller practices up on EMRs even with the promise of incentives. Letting hospitals pay for most of the cost of the system would meet the public policy objectives which prompted the creation of HITECH in the first place.

According to Modern Healthcare, the federal Office of Management and Budget is reviewing proposed rules regarding the Stark exception and the anti-kickback safe harbor. Let’s hope they’re finalized in time to solve the problem.