Cerner

flying cadeucii Black Book: Not so Unbiased and Relevant?

Black Book Rankings announces that it will change its EHR survey methods and remove ballots cast by provider organizations that serve as resellers/VARs, and/or channel partners. The organization reviewed previous surveys and discovered that 33 hospital resellers had cast EHR satisfaction and loyalty ballots for 740 physician practices, and that 93% of the physician practices and small hospitals felt obligated to only select the EHR offered by their hospital.

Well, duh! I have always been a little suspect of Black Book’s survey method since their findings are often so different than the rankings from KLAS. If I were a vendor with a website that proudly displayed a high ranking from Black Book, I think I would quietly remove that reference, at least for now.

Epic Opening App Exchange

Epic Systems is launching its own app store, giving outside companies the ability to market applications that work with Epic’s EHR. According to former Nordic Consulting CEO Mark Bakken, the app store will “open the floodgates” for anyone who knows Epic and wants to get their products in front of Epic clients quickly.

Politically it’s a savvy move, since Epic wants to continue dispelling those rumors that its system is closed and lacks the interoperability of some of its competitors vying for the DoD’s $11 billion EHR contract.

Continue reading “HIT Newser: Black Book Rankings Not So Unbiased?”

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ONC Issues Draft HIT Interoperability Road Map

The ONC releases a draft of its 10-year nationwide interoperability road map, which includes a focus on helping the majority of providers across the care continuum and consumers achieve basic interoperability of health data over the next three years. The ONC also released a draft of its Interoperability Standards Advisory, which includes an assessment of the best available standards and implementation specifications for clinical health information interoperability.

Public comment for the draft Roadmap closes April 3, 2015; comment period for the Standards Advisory closes May 1, 2015.

Meaningful Use Reporting Relief         

CMS proposes rule changes for the EHR incentive program, including a reduction in the 2015 reporting period from one year to 90 days. An additional change would re-align the reporting period to match the calendar year, giving hospitals more time to incorporate 2014 Edition software into their workflows and better align with other CMS quality objectives. CMS will consider additional program modifications to reduce complexity and lessen providers’ reporting burdens.

CMS noted that the proposed rule changes are separate from the upcoming Stage 3 proposed rule that should be be released in March that is expected to limit the scope of the Stage 3 requirements for MU in 2017 and beyond.

Providers, vendors, and professional organizations are breathing a collective sigh of relief over the CMS announcement.  The proposed changes aren’t too surprising, given low Stage 2 attestation numbers and overwhelming provider dissatisfaction with the MU program.

New Valued-based Payment Goals to Drive HIT Adoption

HHS sets a goal for 30 percent of Medicare payments to be link to value-based performance through alternative payment models, such as ACOs, by 2016 and 50 percent by 2018. In addition, HS wants 85 percent of traditional Medicare payments tied to quality by 2016 and 90 percent 2018.

Achieving those objectives will require technology that supports quality-based payments versus the traditional fee-for-service model, so both vendors and providers will need to make aggressive moves to deploy the appropriate tracking and reporting tools. No doubt this will be one of the hotter topics at the HIMSS conference in April.

Continue reading “HIT Newser: A Meaningful Sigh of Relief”

flying cadeuciiEpic  regains its top spot in the 2014 Best in KLAS awards, winning in the Overall Physician Practice Vendor and Overall Software Suite categories. Impact Advisors was named the Overall IT Services Firm.

Last year athenahealth beat out Epic by a narrow margin. This year athena still had an excellent showing, taking the top spots for Practice Management in both the 1-10 physician and 11-75 physician categories, as well as second place (after Epic) in the over 75 physician category.

Epic won Best in KLAS or category leader honors for Acute Care EMR, Ambulatory EMR (11-75 physicians and over 75 physicians), HIE, Lab, Patient Account and Patient Management, Patient Portals, Pharmacy, Radiology, and Surgery Management.

Continue reading “KLAS Announces 2014 Best in KLAS Winners”

An Epic Loss for Cerner and GE

flying cadeuciiMayo Clinic announces it will replace its existing Cerner and GE systems with Epic’s EHR and RCM system.

The prestigious Mayo Clinic name and clinical reputation make the win especially sweet for Epic, which is in the running for the DoD’s $11 billion EHR contract. Analysts estimate that Mayo will pay Epic “hundreds of millions” over the next several years.

Google Glass Confusion

Earlier this month Google announced the end of its Glass Explorer program and sales of its existing version of Glass. Many mainstream publications carried “Glass is Dead” headlines, which is certain attention-grabbing, though not entirely true.

Individual consumers had the option to pay $1,500 to purchase Google Glass through the now-defunct Glass Explorer program. Enterprise businesses, such as HIT vendors Augmedix and Pristine, are still able to buy the existing version of Glass through Google’s Glass at Work program. In other words, if you’re interested in using Google Glass in a healthcare setting, that option is still available through a Glass at Work partner.

Meanwhile, Google says it is working future versions of its Glass product – though no one is saying when the next release will be. Continue reading “HIT Newser: An Epic Loss for Cerner & GE + Google Glass Confusion”

HIMSS and CHIME to HHS: ONC Needs Full-time National Coordinator

In a letter to HHS Secretary Sylvia Burwell, CHIME and ONC stress the need to hire a full-time National Coordinator for the ONC, should Karen DeSalvo continue to serve as both the ONC head and the assistant secretary of health:

“If Dr. DeSalvo is going to remain as the Acting Assistant Secretary for Health with part-time duties in health IT, we emphasize the need to appoint new ONC leadership immediately that can lead the agency on the host of critical issues that must be addressed.”

AMA Calls for Removal of MU Penalties

The AMA calls for all MU penalties to be halted and for the program to be more flexible with a shorter reporting period.  In addition, the AMA urges policymakers to refocus the MU program on interoperability and seek ways to improve product usability.

Cerner Breaks Ground at New Campus

Cerner breaks ground at a new $4.45 billion campus in Kansas City, which is expected to house 16,000 new Cerner employees within the next 10 years. The project includes about $1.75 billion in public tax subsidies.

Continue reading “HIT Newser”

Almost 20 years ago close to 4,000 people from 200 companies gathered in San Diego for a conference to discuss the future of health-care information technology. This was before the Web. This was back when computers in physicians’ offices, to the extent they were present at all, were used only for scheduling and billing patients. Paper charts bulged out of huge filing cabinets.

It was one of the first big conferences held by the Healthcare Information and Management Systems Society (HIMSS). I was among a grab bag of physicians, technologists, visionaries, engineers and entrepreneurs who shared one idealistic goal: to use information systems and technology to fundamentally change health care.

We didn’t just want to upgrade those old systems. We imagined a future that looked a lot like what we were being promised throughout the economy as it sped into the Internet era. Computers would enable improvements in the practice of medicine—and make it safer, higher quality, more affordable and more efficient—all at the same time. We wanted people to be healthier.

Continue reading “Why Haven’t Electronic Health Records Made Us Any Healthier?”

I’m well aware that a good fraction of the people in this country – let’s call them Rush fans – spend their lives furious at the New York Times. I am not one of them. I love the Grey Lady; it would be high on my list of things to bring to a desert island. But every now and then, the paper screws up, and it did so in a big way in its recent piece on the federal program to promote healthcare information technology (HIT).

Let’s stipulate that the Federal government’s $20 billion incentive program (called “HITECH”), designed to drive the adoption of electronic health records, is not perfect. Medicare’s “Meaningful Use” rules – the standards that hospitals’ and clinics’ EHRs must meet to qualify for bonus payments – have been criticized as both too soft and too restrictive. (You know the rules are probably about right when the critiques come from both directions.) Interoperability remains a Holy Grail. And everybody appreciates that today’s healthcare information technology (HIT) systems remain clunky and relatively user-unfriendly. Even Epic, the Golden Child among electronic medical record systems, has been characterized as the “Cream of the Crap.”

Continue reading “The HIT Job”

Anyone who understands the importance of continuity of care knows that health information exchange is essential. How are we supposed to cut waste and duplication from the healthcare system and truly focus on patient welfare if doctor B has no idea what tests doctor A conducted, or what the results were?

The predominant proprietary HIT vendors know this, yet have engaged in prolonged foot-dragging on interoperability and even basic data interfacing. Yes healthcare IT is their business, but interoperability is not in their nature.

As we’ve seen before, the problem is with the business model.

The proprietary business model makes the vendor the single source of HIT for hospital clients. Complexity and dependence are baked into both solutions and client relationships, creating a “vendor lock” scenario in which changing systems seems almost inconceivable.

In the proprietary world, interfacing with third-party products is a revenue generation strategy and technical challenge; the latter, though unnecessary, justifies the former. When we go looking for the reasons that healthcare is a laggard compared with other industries, this single-source model—the obstacle to much-needed competition and innovation—is a primary culprit.

To be fair, provider organizations, with little if any incentive to exchange patient data before the advent of Meaningful Use, haven’t shown much collaborative spirit either. In the fee-for-service model, why would a healthcare organization let patients slip from their grasp? Health reform is finally mandating needed change, but when will proprietary vendors actually enable the interoperability hospitals and practices soon have to demonstrate?

Recent rumblings from Washington, DC, suggest the feds are losing patience.

Continue reading “Is Interoperability Possible in HIT? And if it Is, Do We Even Want it?”

We should have seen it coming, really. It was entirely predictable, and the most recent RAND report proves it.

We incentivized comprehensive IT adoption, making it easier to bill for every procedure, examination, aspirin, tongue depressor, kind word and gentle (or not) touch without first flipping the American healthcare paradigm on its head, if such a thing is even possible.

According to analysis by the New York Times, hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier. Overall, the Times says, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments at higher levels from 2006 to 2010 … compared with a 32 percent rise in hospitals that have not received any government incentives …”

To paraphrase the mantra of Bill Clinton’s successful 1992 presidential campaign: It’s the system, stupid. More specifically, it’s the business model, stupid, the fee-for-service system in which electronic health records are enabling tools.

It’s also the law of unintended consequences. You know … you take action, planning on this but instead you get that.

Like the introduction of cane toads in Australia to kill beetles (they couldn’t jump high enough). Like letting mongooses loose in Hawaii to manage the rat population (they preferred native bird eggs). Like Kudzu, the insatiable vine that’s devouring the South.

According to the authors of the RAND report, the problem is with the incentive structure that encourages more tests and procedures. Well, of course it is. Doctors and administrators have a clinic or hospital to run. They have expensive invoices from Epic and Cerner to pay. They can now track and bill for all this stuff they used to not get paid for. Are we surprised?

And meanwhile, fee-for-service leads us down a contradictory rat hole of massive healthcare costs and lousy public health. Continue reading “It’s the System, Stupid: Reversing the Law of Unintended Consequences”

What a week last week! First the disgraced cyclist confession and later the baffling college-football-player-and-his nonexistent-(dead)-girlfriend story, with the RAND report sandwiched somewhere in between. It’s positively a scandal-palooza.

What’s that? You don’t feel like the recent RAND report, which basically says that a 2005 RAND study financed by GE and Cerner was wildly optimistic in predicting about $81 billion in potential health care cost savings through widespread adoption of electronic health records, qualifies as a genuine hoax, controversy, scandal?

Me neither.

But it does neatly frame what is arguably a unique characteristic of the healthcare industry—a trait that extends to peripheral industries as well. Basically, healthcare is an interconnected environment. Call it the systems theory of healthcare, co-dependency … or just regular dependency. Call it what you want, but there is an interconnectedness in healthcare that we ignore at the expense of national wellness.

Witness key data points provided by the RAND report:

  • Modern health IT systems are not interconnected and interoperable, functioning “less as ‘ATM cards,’ allowing a patient or provider to access needed health information anywhere at any time, than as ‘frequent flier cards’ intended to enforce brand loyalty…”
  • Neither are they widely adopted, with an estimated 27 percent of hospitals utilizing a basic electronic record. Without broad adoption, interoperability is far less relevant.
  • Improvements in quality of care / patient safety and reductions in healthcare costs (which have grown by $800 billion since 2005) are not manifesting with EHR adoption, in part because hospitals and clinics are rushing to adopt mediocre solutions and garner federal funds.
  • The provision of care is the same as it ever was, even though EHRs are frequently promoted as the optimal tool for a different kind of care.

The reasons for these disappointing stats are readily apparent and unalterably interconnected.
Continue reading “Are Healthcare and Health IT in a Dysfunctional Relationship?”

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