By MICHAEL LAKE

EHR vendor performance and project ROI.  KLAS, a health IT product and vendor rating service based on client satisfaction, reported its annual Best in KLAS awards.  For ambulatory EHR systems Epic, eClinicalWorks, Greenway and e-MDs lead their categories by physician practice size, from largest to smallest.  Epic also leads for acute care organizations > 200 beds.  McKesson is best for smaller organizations.  Siemens is most improved.  And there was some interesting cost analysis by CDW, a hardware distributer, which shows us that the biggest expense in an EHR project is potential lost physician revenue.  First year hardware, software and service costs average only 12%, with the rest, $101,250 resulting from physicians seeing fewer patients. Smarter projects can likely do a lot to address this.

Analytic models help demystify the HIT environment.  The government’s Meaningful Use model was updated with its ideas for Stage 2 (2013) and Stage 3 (2015).  Requirements are increased in this stage.  For example, e-prescribing has to touch 40% of patients in Stage 1.  This increases to 50% in Stage 2 and 80% in Stage 3.  The optional measures from Stage 1 become core, for example, formulary checking.  And there are new requirements including chart notes, online patient messaging and a longitudinal care plan. 

PricewaterhouseCoopers (PwC) maps the three stages of meaningful use to three stages of accountable care.  Stage 1 is planning for the ACO; Stage 2 is participating in the ACO; and Stage 3 is performing in the ACO.  John Glaser, CEO at Siemens Health, proposes a model of eight critical IT functions needed to thrive in an accountable care world.  These include patient tracking, decision support, registries, care collaboration tools, event messaging, PHRs, HIEs and analytics.  Glaser sees the ACO provisions in the Affordable Care Act more significant to HIT than the meaningful use regulation itself.

The National Quality Forum (NQF) released some basic models for reporting quality that will be useful.  It suggests a three-part model to assess HIT utilization:  Actors, Content and Actions.  And it suggests a clinical decision support model with four functional categories:  Triggers, Input Data, Interventions and Action Steps.  Both are simple constructs that help provide a structure for moving ahead.

And Mark Anderson, CEO at AC Group, an industry analyst and consulting firm, proposes a model comprised of five types of HIEs.  Type 1 is focused on physicians getting patient data from the hospital.  There’s no sharing among providers. Type 2 is focused on sharing data among practices with the same EHR.  Type 3 is focused on sharing specific data with a short list of selected EHRs, via point-to-point interfaces.  Type 4 is focused on the exchange of CCD data with selected EHRs and Type 5 is exchanging CCD data with different EHRs.  Each type includes vendor offerings in federated (point-to-point) or non-federated (central repository) solutions.

China launches the largest telehealth monitoring project ever.  Ideal Life, a Canadian telehealth company, announced the largest industry project to date, a 100,000 citizen wireless monitoring project in China.  It is partnering with Chinese pharma, NovaTech Biological Pharmaceutical.  The platform allows for two-way communication between patients, providers and health coaches.  Citizens will use kiosks in community centers and wireless devices in the home.   

The Art of HIT.  Industry analysts, in their annual forecasts, all see mobile and smartphones and tablets as a most important trend.  Even David Hockney, a renowned contemporary artist in the UK, succumbs with a recent Paris exhibition of different images on 40 smart devices, all created with the iPad app, Brushes.  It is the year of mobile health and the consumer.

This is a summary of the HIT Trends Report for January 2011.  You can get the current issue or subscribe here. Michael Lake has been a healthcare technology strategist for over 30 years.  He is President of Circle Square Inc., a San Francisco-based strategy, business development and market research firm, focused exclusively on the healthcare information technology market. The company works with healthcare, life sciences and technology companies on developing strategies, products and business models for complex multi-stakeholder healthcare environments.  He publishes the HIT Trends Report monthly.  For more information, please see www.michaellake.com.